eSymposium 2021 Abstracts presented

Abstracts by Region

These abstracts are organised by region. Select a tab to access the corresponding abstracts.

M. Ahmed, E. Wedekind, Y. Chen, C. McPherson, D. Sellen. A systematic review on measurement methods to assess school food environment.

Introduction: The food environment of schools is important; a third of children’s daily energy intake is consumed at school. The school food environment represents an effective setting for interventions to influence children’s food choices at a time when dietary habits are developed. However, heterogeneity and complexity of the school food environment presents a challenge in determining best practice measurement tools to assess the school food environment. Limited research exists on the types and quality of the measurement tools for school food environments, which are needed to inform future policies and practices, and none investigated for the Canadian context. The objective was to review and assess the quality of measurement tools for the school food environment. Methods: Five databases were searched, and the tools were categorized according to the INFORMAS dimensions of the food environment (physical, economic, socio-cultural and policy) and the Centre for Disease Control framework to assess components of school nutrition environment. Results: Of the 97 global studies, the physical environment was the primary focus for 85%, aspects of policy assessed by 72%, followed by the socio-cultural environment (67%) and a small number of studies assessed the economic (18%). Although 84% of articles measured more than one dimension, 16% measured only one dimension while only 6% measured all dimensions of the school food environment. Discussion and Conclusion: Findings indicated a substantial gap in the measurement of economic dimension of the school food environment. Research is ongoing with quality assessment of the measurement tools and compilation of best available tools in assessing the school food environment.

K. Backholer, S. Seenivasan, J. Marshall, O. Huse, C. Zorbas. The impact of the Covid-19 pandemic on food and beverage prices in Australia.

The global COVID-19 pandemic represent a major food system shock. We aimed to comprehensively analyse the impact of COVID-19 on the price of foods and beverages sold by a major grocery retailer in Australia. We analysed 106 weeks of data from the Australian PriceTracker database (which has price for 16,000+ foods and beverages, collected weekly, from online supermarkets). We developed minor and major food categories for analysis that grouped foods with similar characteristics aligned to healthiness and sensitivity to food system disruptions. Our final sample for analysis included 7051 products across 413 minor food categories. Regression models were fit at the minor food category level, with estimates combined using meta-analysis to obtain price changes for 41 major food categories. The dependent variable was category-level price and independent variables included seasonality (summer, spring, autumn or winter), bushfire season, and Consumer Price Index (CPI). Results show that prices were higher in 57% (n=236) of the minor food categories during the COVID period compared to the pre-COVID period, with most prices remaining high after the first COVID wave had passed. Prices increased most for fruit (7.1%) and processed meats (5.3%). Other major staple food categories that increased in price included (but is not limited to) long-life milk (3.28%), legumes (3.1%), fresh milk (2.44%) and oils (3.85%). When combined with the decrease in income for many Australians, these price increases are likely to have exacerbated impacts on food affordability, food stress and food insecurity.

H. Eyles, S. Dodd, Y. Jiang, T. Gontijo de Castro. Annual household purchases of sugar sweetened, artificially sweetened, and unsweetened beverages in New Zealand: a time-trend analysis using NielsenIQ Homescan market research data.

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S. Ferreira, T. Gontijo de Castro, C.R. Wall, S. Gerritsen, J.A. Teixeira, C.C. Grant, S.B. Morton, D.L.M. Marchioni. Early and late introduction of complementary foods: prevalence and determinants in New Zealand (NZ)

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N. Flexner, A.K. Christoforou, J.T. Bernstein, A. Ng, E.A. Fernandes Nison, M-E. Labonte, M.R. L’Abbe. Estimating the number of CVD deaths that could be averted or delayed if Canadian adults reduced their mean sodium intake to recommended levels.

Canadians’ mean sodium intake (2,758 mg/d) is well above recommended levels. Reducing dietary sodium intake through food reformulation has been identified as a cost-effective intervention. This study aimed to estimate the number of CVD deaths that could be averted or delayed if Canadian adults reduced their mean sodium intake to recommended levels under three scenarios: A) 2,300 mg/d – driven by a systematic reduction of sodium levels in packaged foods (reformulation); B) 2,000 mg/d to meet the World Health Organization recommendation; and C) 1,500 mg/d to meet the Adequate Intake recommendation. Modelling was conducted using the Preventable Risk Integrated ModEl (PRIME). Inputs for the model included Canadian age- and sex- specific data on actual sodium intake (baseline scenario), sodium intake at recommended levels (3 counterfactual scenarios), CVD mortality data and population demographics for the year 2019. Between 2,176 (95% CI 869-3,687) deaths under scenario A, and 5,296 (95% CI 2,190-8,311) under scenario C, due to CVDs could have been averted or delayed, mainly from ischaemic heart disease, stroke, and hypertensive disease, by reducing Canadians’ sodium intake to recommended levels. This represents between 3.9% and 9.5% of the total number of CVDs deaths observed in Canada in 2019. Results suggest that reducing sodium intake to recommended levels could prevent or postpone a substantial number of CVD deaths in Canada. Reduced sodium intakes could be achieved through reformulation of the Canadian food supply. However, it will require higher compliance from the food industry to achieve Health Canada’s voluntary benchmark sodium reduction targets.

K. Garton, S. Mackay, S. Gerritsen, F. Sing, K. Lin. Digital marketing environments in Aotearoa New Zealand: results from a national assessment of company websites, Facebook pages and YouTube channels.

Background: Currently in Aotearoa New Zealand (NZ), advertising is self-regulated by the industry-led Advertising Standards Authority (ASA), including a Children and Young People’s Advertising (CYPA) Code; however, experts have repeatedly expressed concern that the ASA system does not adequately protect children from the exposure to, and power of, unhealthy food marketing. Objective: Describe the extent and nature of unhealthy food and beverages (UFB) marketing on company-owned digital platforms in NZ between 2019-2021, following implementation of the CYPA Code. Methods: Content analysis of company websites, Facebook pages, and YouTube channels of the most popular food and beverage brands. Brands were selected based on web traffic analysis and consumer engagement (Facebook page ‘Likes’ and YouTube page views). Analysis focused on volume and type of food posts/videos, level of consumer interaction, nutritional quality of foods pictured, and use of specific marketing techniques. Results: The sample included 64 company/brand websites, 32 company Facebook pages, and 15 YouTube channels. 81% of websites (n=52) featured marketing of UFB. 35% of websites featuring UFB used power strategies positioning their products as ‘for kids’; a further 13% used ‘family-oriented’ messaging. Several websites featuring UFB also had designated sections for children, ‘advergaming,’ or direct messaging to children. % of all food and drink company Facebook posts and YouTube videos were classified as unhealthy. 28% of Facebook posts for UFB featured power strategies, and 39% premium offers. Nearly 30% of YouTube videos for UFB featured power strategies, and 13% premium offers. 10% of Facebook posts of UFB used marketing techniques specifically targeting children, young people and/or families. Conclusions: The voluntary CYPA Code has been in effect since 2017, but companies still market UFB on digital platforms. There are clear loopholes for companies to continue marketing UFB in ways that appeal to children. Comprehensive regulation is needed to protect NZ children from harmful marketing.

A. Gaucher-Holm, C. Mulligan, M. L’Abbe, M. Potvin-Kent, L. Vanderlee. Lobbying and nutrition policy in Canada: Stakeholder interactions with government officials in the context of Health Canada’s Healthy Eating Strategy.

Introduction: The political activities of industry stakeholders must be understood to safeguard the development of public health policies. Methods: A quantitative descriptive study used data from Canada’s Registry of Lobbyists to examine the frequency and governmental target of lobbying between various types of stakeholders (i.e., industry versus non industry) and designated public office holders (DPOH) regarding Health Canada’s Healthy Eating Strategy, from September/2016 to January/2021. Initiatives of interest were revisions to Canada’s Food Guide, changes to the nutritional quality of the food supply, front-of-pack nutrition labelling and restrictions on food marketing to children. Results: The majority of registrants (88%), and clients, corporations and organizations (90%) represented in lobbying registrations had industry ties. Industry-affiliated stakeholders were responsible for 86% of communications with DPOH, and interacted more frequently with DPOH of all ranks. Most clients, organizations and corporations explicitly registered to lobby on the topic of marketing to children (60%), followed by Canada’s Food Guide (48%), front-of-pack nutrition labelling (44%), and the nutritional quality of the food supply (23%). The food and beverage industry, particularly the dairy industry, was the most active, accounting for the greatest number of lobbying registrations and communications. Discussion: Industry-affiliated stakeholders actively lobbied on topics related to the Healthy Eating Strategy, to a much greater extent than non-industry counterparts. Conclusion: Results suggest a strategic advantage of industry stakeholders in influencing Canadian policymakers. While some safeguards have been put in place, increased transparency would allow for a better understanding of industry discourse and help protect public health interests during the policy development process.

S. Gerritsen, F. Sing, K. Lin, A. Culpin, M. Araya, L. Ellis, S. Mackay. COVID-washing on social media by unhealthy food/drink brands during the COVID-19 lockdowns in New Zealand.

Introduction: COVID-washing is the misappropriation of the health and societal response to the pandemic for promotion of a brand or company. This study investigated the timing, nature and extent of COVID-washing on social media accounts of New Zealand’s major food/drink brands during community outbreaks. Method: Content analysis of social media posts from February-May 2020, repeated in July-September 2021, for the 20 largest confectionery, snacks, non-alcoholic beverages, and fast-food brands. COVID-19-related posts were identified and classified to investigate timing, themes and engagement. Results: 14/20 unhealthy food/drink brands referenced COVID-19 during the initial 4-month period, peaking during nationwide lockdown restrictions. Over a quarter of all posts (n=372, 27.2%) were COVID-themed. Fast-food brands were most likely to use COVID-themes (n=251/550 posts, 46%), had the highest number of posts overall, and the most engagement. Common themes were to draw on feelings of community support (in 36% of all COVID-19-related posts), brand-related isolation activities (23%), and “consumption helps with coping” (22%). Six posts were found to potentially breach advertising standards codes by promoting excessive consumption or targeting children. Similar results were found in 2021. Discussion: COVID-washing was used by unhealthy food/drink brands to increase brand loyalty and encourage consumption among vulnerable populations during a time of increased stress and hardship. The current self-regulated Advertising Standards system is ineffective and must be replaced with government legislation to effectively regulate unhealthy food/drink advertising on social media, particularly in times of crisis.

T. Gontijo de Castro, S. Gerritsen, L. Pozza Santos, D.L.M. Marchioni, S.B. Morton, C.R. Wall. Adherence to national food and nutrition guidelines among 24 and 54-month-olds in New Zealand (NZ).

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A. Jones, M. Shahid, G. Morelli, K. Howes, D. Riesenberg, G. Sacks. The prevalence of child-directed marketing on food packaging in Australia.

Background: Evidence shows children’s exposure to food marketing influences brand awareness, food preferences, purchase requests and consumption. Food companies use a range of strategies to market their products and brands as part of intergrated marketing communications. Our aim was to explore the prevalence of child-directed marketing on food packaging in Australia. Methods: We used product packaging and nutrient content data from four large supermarkets in Sydney in 2019, and selected seven focus categories for analysis (biscuits, cakes, confectionery, breakfast cereals, non-alcoholic beverages, dairy, snackfoods and baby foods). Existing literature and regulation was used to develop a framework of child-drected marketing techniques. Techniques were grouped into two major categories: child-directed characters, and non-character based elements that appeal to children. Within these, ten specific techniques were identified. Two coders recorded the prevalence of these techniques on pack. We assessed the healthiness of products that were, and were not, using child-directed marketing using a variety of nutrient profiling models, and provided summary data overall, by specific marketing technique, by category, and by manufacturer. Results: We will present preliminary results on the prevalence and types of marketing to children on product packages, and provide insight into the healthiness of these products using multiple objective metrics. Conclusion: Children are commonly targeted by marketing on food packaging, particularly on unhealthy products. Monitoring of child-directed marketing on food packaging can provide important evidence to inform policymakers as part of future food labelling and marketing reform efforts.

B. Kelly. Digital media monitoring in Australia.

Introduction: Food is one of the most frequently promoted commodities and promoted foods are overwhelmingly unhealthy. Marketing normalises unhealthy foods, creates positive brand images and encourages overconsumption. Limited research is available to describe the extent of food marketing to children on online media and measuring actual exposure is challenging. This study aimed to monitor the extent of children’s exposure to online media food marketing, as an essential step in increasing the accountability of industry and governments to protect children. Methods: Children aged 13-17 were recruited in October 2018-March 2019. Children recorded their mobile device screen for two weekdays and one weekend day anytime they visited relevant online platforms. After each day, participants uploaded video files to a secure server. Promoted products were defined using the World Health Organization (WHO) Europe Region nutrient profile model.
Results: The sample of 95 children uploaded 267.8 hours of video data. For every hour that a child spent online on their mobile device, they saw a median of 17 food promotions. Exposures to unhealthy food marketing on digital media was almost nine times higher than children’s exposure via television advertising, based on the most recent Australian television advertising monitoring data. Considering usual time online on mobile devices, over a week children would be were exposed to an average of 168 online food and drink promotions, 100 of which would not be permitted to be marketed based on nutrient profiling criteria. Most promotions (59%) were peer endorsed and derived from third parties sources.
Discussion: The majority of food brand content that children see online is seemingly endorsed by peers or online communities but is likely initiated by brands. Food brands are able to tap into these pages’ networks of online followers and social cache, heightening the marketing effect. Regulations to protect children from this marketing must extend beyond paid advertising to paid content in posts generated through online communities and influencers.

B. Kidd. Cost and greenhouse gas emissions of different diets.

Background: Currently food systems are substantial contributors to environmental damage and health loss, with cost a significant determinant in affording healthier compared to unhealthy food. Objectives: To compare the costs and climate impact (greenhouse gas emissions) associated with current (based on national nutrition surveys) and healthy (based on dietary guidelines) diets and two healthy and environmentally friendly dietary patterns: flexitarian and vegan (based on the EAT-Lancet planetary diet). Methods: The DIETCOST programme (a python-based, iterative, multiple solution solver that finds diet outputs that fit constraints) was used to model the cost differential between the four diets. Climate impact measures (kg of CO2 equivalent emissions per kg of food product), food prices, and each dietary scenarios were incorporated into DIETCOST. Results: There were stepwise differences between diet scenarios (P<0.001) with the current diet having the lowest mean cost (95% CI) in New Zealand Dollars of $584 ($580-588) per fortnight for a family of four) but highest mean (95%CI) climate impact of 597 kgCO2e (590-604) followed by the healthy diet at $637 ($632-642) and 452 kgCO2e (446-458), the flexitarian diet at $728 ($723-734) and 263 kgCO2e (261-265), and the vegan diet, which had the highest mean cost and lowest mean climate impact at $789 ($784-794) and 203 kgCO2e (201-204). Discussion: Moving from current diets towards diets which are healthy and sustainable will improve health and reduce climate impacts but at a higher cost to households. Among other things, fiscal policy action is needed to reduce cost barriers for eating sustainable healthy diets.

J. Lee, A.P. Ng, M. Ahmed, N. Flexner, M. L’Abbe. Nutrient Intakes and Sources of Foods Categorized by the Proposed Canadian Front-of-Pack Label Policy among Canadian Adults

Canada proposed mandatory front-of-pack label (FOPL) regulations in 2018, where foods exceeding recommended thresholds for nutrients-of-public health concern (i.e., saturated fat, sodium, and total sugars) must display ‘high-in’ symbols. The objective of this study was to examine the intakes of nutrients-of-public health concern from foods that would carry FOPL and the top contributing food categories to intakes in Canadian adults. Using a nationally representative one-day 24-hour dietary recall from the 2015 Canadian Community Health Survey, intakes of nutrients-of-public health consumed from foods that would carry FOPL were examined by Canadian adults (n=13,693). Foods were classified using Health Canada’s Tables of References Amounts and grouped into 62 mutually-exclusive categories to identify the top 10 food sources for each nutrients-of-public health concern that would carry FOPL. On average, Canadians consumed 788±20 kcal/d (means±SEM; 38% of total calories) from foods that would carry FOPL (i.e., high in nutrients-of-public health concern). Foods that would carry ≥1 FOPL for exceeding nutrient thresholds contributed 50% of saturated fat (5.9±0.2% of total daily intake), 46% of sodium (1,270±28 mg/d), 39% of total sugar (8.4±0.4% of total daily intake), and 59% of free sugar (7.0±0.3% of total daily intake) among Canadian adults. There was little overlap among top nutrient contributors of foods that would carry FOPL for the different nutrients (e.g., processed cheese for saturated fat, breads for sodium, and sodas for total sugars). Our findings show that the proposed FOPL regulations in Canada have the potential to reduce the intakes of nutrients-of-public health concern among Canadians.

M. Lewis, S.A. McNaughton, L. Rychetnik, A.J. Lee. Cost and Affordability of Healthy, Equitable and Sustainable Diets in Low Socioeconomic Groups in Australia

Introduction: Few Australians consume a healthy, equitable and sustainable diet consistent with Australian Dietary Guidelines. Low socioeconomic groups (SEGs) suffer particularly poor diet-related health problems. However, granular data on dietary intakes and affordability of recommended diets was lacking for low SEGs. This study meets an identified need for better evidence to support policies to improve food environments and help drive healthier diets in low SEGs in Australia. Methods: The Healthy Diets Australian Standardised Affordability and Pricing protocol was modified to align with relevant low SEG dietary intakes reported in the National Nutrition Survey 2011-2012, household structures, food purchasing habits, and incomes. Cost and affordability of habitual and recommended diets were calculated using prices of ‘standard brands’ and ‘cheapest options’. Results & Discussion: While total energy intake was similar, habitual diets of low SEGs included less healthy and more discretionary food and drinks than the broader population. With ‘standard brands’, recommended diets cost less than habitual diets, but were unaffordable for low SEGs. With ‘cheapest options’, both diets were more affordable, but recommended diets cost more than habitual diets for some low SEGs, potentially contributing to perceptions that healthy food is unaffordable. Conclusion: An equity lens is needed to better target nutrition policies to support low SEGs. Action is urgently needed to help improve affordability of recommended diets by further decreasing cost of healthy, relative to unhealthy, foods and ensuring low SEGs have adequate incomes.

S. Mackay, S. Gerritsen, F. Sing, B. Swinburn. Implementing healthy food environment policies in New Zealand: Nine years of inaction.

Introduction: The INFORMAS Healthy Food Environment Policy Index (Food-EPI) evaluates the degree of implementation of food environment policies by national governments against international best practice. Food-EPI has been applied previously in New Zealand in 2014 and 2017. Methods: In 2020, a national panel of over 50 public health experts participated in Food-EPI. Experts rated the extent of implementation of 47 ‘good practice’ policy and infrastructure support indicators compared to international best practice, using an extensive evidence document. Experts then proposed and prioritised concrete actions needed to address the critical implementation gaps identified. Progress since 2014 and 2017 was compared. Results: 60% of indicators were rated as having ‘low’ or ‘very little if any’ implementation in 2020 compared to international benchmarks; less than 2017 (47%) and similar to 2014 (61%). Of the nine priority actions proposed in 2014, there was only noticeable action on one (Health Star Ratings). The majority of actions were therefore proposed again in 2017 and 2020. Discussion: Actions proposed by experts in 2020 were broader, reflecting the need for multi-sectoral action to improve the food environment, recognition of the social determinants of health, and the need for a mandatory approach in all policy areas. Conclusion: There has been little to no progress in the past three terms of government (nine years) on the implementation of policies and infrastructure support for healthy food environments. Recommendations will require the involvement of many Government entities to overcome the existing policy inertia.

L. Minaker. Point of Sale Food and Beverage Marketing to Kids: Tool development and evidence from three cities in Canada.

Introduction: The World Health Organization called for global action to reduce the impact of marketing unhealthy foods and beverages to children over a decade ago. Several countries, such as Mexico, Ireland, and Chile, have implemented laws that restrict food and beverage broadcast marketing to children (M2K). Canada is currently considering legislation to prohibit unhealthy food and beverage M2K. To date, national M2K policies and monitoring predominantly focuses on broadcast media: television, radio, and social media. There are currently major gaps in policy and research on point-of-sale M2K in food retailers and restaurants. Methods: Working with Health Canada’s Office of Nutrition Policy and Promotion, I recently developed and tested two tools: the Child Appealing Marketing Assessment Tool for Stores (CAMAT-S) assesses point-of-sale M2K in food retail establishments (e.g., supermarkets and corner stores) while the CAMAT-R assesses point-of-sale M2K in restaurants. Tools were developed based on literature syntheses and expert consultations, and inter-rater reliability testing is ongoing. I have secured funding to undertake a 3-city study to examine point-of-sale M2K in St. John’s, Newfoundland, Saskatoon, Saskatchewan, and Kitchener, Ontario. Results: Preliminary results will be presented, including the inter-rater reliability of the tools and the prevalence and distribution of point-of-sale marketing in these three cities. Discussion: These tools can be adapted for use in other countries to demonstrate the need for M2K policies to consider and monitor point-of-sale marketing in addition to broadcast marketing.

E. Pauzé, L. Remedios, M. Potvin-Kent. Children’s exposure to food and beverage advertising on broadcast television in a regulated environment in Canada.

Introduction: The Canadian province of Quebec has restricted commercial advertising directed to children under 13 for decades. The purpose of this study was to quantify and characterize children’s exposure to food advertising on broadcast television in this jurisdiction and examine temporal trends. Methods: Television advertising and viewership data from May 2011 and 2019 for 18 stations broadcast in Montreal (Quebec) were licensed for 19 food and beverage categories. The exposure of Francophone children aged 2-11 years was estimated using advertisement ratings data. The number of broadcast food advertisements and children’s exposure, overall, by food category and by station type, were determined and compared across time. Results: Although the number of food advertisements increased by 11% across all stations in May 2011 (n=41,084 ads) and 2019 (n=45,406 ads), children’s exposure decreased by 53% (226 ads/child in May 2011 and 107 in May 2019). Nevertheless, unhealthy food categories such as fast food (41% of ads viewed/child), candy and chocolate (6.3%) and savory snack foods (e.g. chips; 7.5%) constituted the majority of ads viewed by children in May 2019. Youth appealing stations (n=3) accounted for only 11% of children’s total food advertising exposure in May 2019. Discussion/Conclusion: Despite being proposed as a model for other countries developing food marketing restrictions, Quebec’s Consumer Protection Act (CPA) does not effectively protect children from exposure to unhealthy food advertising on broadcast television. Marketing restrictions need to not only reduce the appeal of food advertising among children, as the CPA does, but must also be designed such that children’s exposure is reduced.

M. Potvin-Kent, F. Hatoum, D. Wu, L. Remedios. Assessing Canadian children’s exposure to food marketing in various media and settings.

Introduction: Food marketing is a determinant of child dietary intake. Children are exposed to unhealthy food marketing in media such as television, and digital media as well as in child settings such as schools. In 2019, the Canadian Federal government recommended the introduction of regulations that restrict food marketing to children. The purpose of this scoping review was to provide an up-to-date assessment of Canadian children’s exposure to food marketing in various media and settings in order to determine where gaps in the research exist. Methods: Detailed search strategies were used to identify both peer reviewed and grey literature published between October 2016 and May 2020 that examined the frequency of food marketing to children or adolescents or their actual exposure to this food marketing. Results: In total, 21 articles were identified; 17 were peer-reviewed and 4 were from the grey literature. Twenty-two studies examined the frequency of food marketing while 2 examined child or adolescent actual exposure to this marketing. Most research focused on television and digital media while gaps in media such as online gaming and settings such as recreational centres and convenience stores were noted. Focus was frequently placed on children to the exclusion of pre-schoolers and adolescents and most data were collected in Ontario and Quebec. Discussion: Research that covers the spectrum of food and beverage marketing is required. More nuanced research that considers, exposure by age, geographic location, gender, race/ethnicity, and socioeconomic status is also needed to inform future government policies and protect children’s health.

V. Provencher, J. Perron, S. Pomerleau, P. Gagnon, A. Corriveau, M-E. Labonte, L. Trudel. The Food Quality Observatory and its contribution to the assessment of food composition in Canada.

The Food Quality Observatory (Observatory) aims to monitor the evolution of the food supply with the objective to generate data that contribute to the collective effort of improving the quality and accessibility of food. The work done by the Observatory currently supports two policies implemented by the Quebec government. For that purpose, food categories to be monitored were first identified following a consultation among the Knowledge Users Committee, which includes key stakeholders from public health, consumers, and the agri-food industry. These results were then reviewed and prioritized by the Scientific Committee. Food composition and price monitoring is conducted for a total of 15 key processed food categories, with measurements combining nutrition labelling information and food sales data. Portraits for 13 categories are currently available on the Observatory’s website (see; most reports are available in French only). As an example, data analyzed in collaboration with Health Canada for the pizzas’ food category have shown that vegetable pizzas have a lower sodium content while pizzas with deli meats have a higher calorie, fat and sodium content than the other types of pizzas. Moreover, traditional crust pizzas have a higher sodium content, whereas thin-crust pizzas have a higher content in saturated fats. In summary, the generated data allow various partners and policymakers to locate and track areas of improvement within key processed food categories in accordance with consumer purchases over time. These data will contribute to the monitoring efforts to examine improvements in the nutritional quality of the Canadian food supply.

R. Prowse, E. Hobin, D.L. Olstad, M. Warken, H. Vatanparast, S.F.L. Kirk, P.J. Naylor, K. Raine. Presence and Value of Food Sponsorship Agreements in Canadian Recreation and Sport Facilities

Introduction: Recreation and sport facilities (RSFs) receive financial support from corporate sponsors to improve sport access. We evaluated the nature, extent, and value of food and non-food sponsorship agreements RSFs in Canada. Methods: An online survey, completed by 79 RSF managers/directors across ten provinces (Dec 2020-Mar 2021), identified the presence and value (financial/in-kind) of RSF sponsorship agreements. Descriptive statistics (median, IQR, proportions) examined the prevalence and count of agreement characteristics. Results: Most RSF hosted children’s sports teams (90%), were publicly funded (63%), and had food sponsor(s) (59%). RSF with sponsors had a median of two food sponsors and 12 non-food sponsors. Sponsors provided $9,250 (IQR:$3,215, $21,500) in cash annually per RSF, with a portion provided by food sponsors ($2,075, IQR:$100, $4,813). More RSF reported receiving non-financial donations (95%) (e.g., signage, free products) than cash (69%) from food sponsors. RSFs that were urban, private or not-for-profit, non-ice, and/or had more child users appeared to have higher food and total sponsorship income. Discussion: Food sponsorship of RSFs in Canada is common and provides cash and in-kind donations. Depending on the RSF, food sponsorship may have a greater/lesser impact on its financial viability. Future analyses will examine the healthfulness of food sponsors, and characteristics of ‘high’ versus ‘low’ paying sponsors. Conclusions: RSFs engage in sponsorship initiatives that may include a variety of branding/marketing. The financial value of food sponsorships should be appropriately weighed against the risk of food marketing exposure.

E. Reeve, K. Backholer, F. Watson, R. Kupka. Tools and measures for assessing key dimensions of school nutrition environments.

Background and purpose: The school setting provides a critical opportunity for promoting health, and policies that promote food and nutrition within schools are recommended as a priority intervention to address malnutrition in all its forms. However, there has been relatively little attention on the status of school nutrition environments in LMICs, or the effectiveness of guidelines and policies in shaping them. The objective of this scoping review was to identify appropriate tools for measuring different dimensions of school nutrition environments. Methods: We searched for tools to measure four key dimensions of the school nutrition environment, as relevant to UNICEF’s Programming Guidance for Nutrition in Middle Childhood and Adolescence. We extracted data from monitoring and assessment tools being applied in EAPR countries and other countries, in addition to the published literature, and analyzed it against a predetermined framework. Results: The majority of assessment tools measured the food environment, which included the healthfulness or affordability of foods being retailed within the school, the support of the broader school community, presence and purpose of school food gardens, physical activity infrastructure and access to drinking water. Tools assessing provision of micronutrient supplementation and nutritious foods (e.g. meal programs) largely did so for financial accountability purposes. The integration of nutrition and physical activity into the curriculum was much less frequently assessed as a part of school nutrition environment monitoring. Conclusions: There is a need to develop a tool that comprehensively assesses and conveys key aspects of school nutrition environment in order to inform strengthened policy action in this space.

E. Robinson, G. Sacks, C. Parker, R. Carey, A. Foerster, M. Blake.  The potential role of institutional investment in driving food industry accountability for nutrition – practices, barriers and facilitators.

Introduction: Superannuation funds and other institutional investors play a key role in influencing corporate governance, and are increasingly incorporating environmental, social and governance considerations as part of their investment decisions. By taking into account nutrition issues, these investors represent a potential avenue for increasing food industry accountability for their impact on population diets. This study aimed to (1) investigate the extent to which nutrition-related issues are incorporated within institutional investment decision-making in Australia, and (2) explore stakeholder perspectives on barriers and facilitators to change. Methods: We conducted a desk-based review of a ‘best practice’ sample of Australian institutional investors. We searched policy documents, reports and websites to identify how nutrition was incorporated within investment decision-making. 15 in-depth interviews were then conducted with various investment sector stakeholders. Results and discussion: 18 out of 35 investors reported incorporating nutrition-related considerations within their decision-making, albeit in limited ways. Examples included investors actively engaging with food companies to encourage improved nutrition-related policies and practices, and screening food companies based on the healthiness of their product portfolios. Barriers and facilitators to change identified by stakeholders included: investor beliefs and experience; quality and availability of nutrition-related data and good practice benchmarks; client and member demand; and government policy action. Conclusion: The public health community needs to collaborate with institutional investors to understand mechanisms that could support better incorporation of nutrition issues as part of investment decisions. Better articulation of the financial risks that unhealthy diets pose to investors is likely to be important.

M. Rosin, L. Young, Y Jiang, S. Vandevijvere, W. Waterlender, S. Mackay, C. Ni Mhurchu. The Price Is Right: Prevalence and effect of promotions on breakfast cereal sales in a large supermarket chain in New Zealand.

Introduction: Pricing and other promotional strategies are used by retailers to influence shoppers’ choices and increase product sales. We examined the frequency of promotions on breakfast cereal products in a major New Zealand supermarket chain, determined the healthiness of promoted versus non-promoted products, and quantified the effects of promotions on sales. Methods: Weekly in-store data on product promotions and sales were collected in six Auckland supermarkets for 198 breakfast products over 12 weeks (April-July 2019). The frequency of promotions was calculated. Product nutrient profile was determined using the Health Star Rating system, and the effect of promotions on sales was estimated using linear mixed models. Results: On average, 60% of the products in a given week were promoted using shelf tickets, 24% via promotional displays, and 12% in weekly mailers. The mean Health Star Rating of promoted and non-promoted breakfast products was comparable. All three promotional methods had substantial (+152%, +263%, and +178% respectively) and statistically significant (P <.001) effects on product sales. Discussion: Our study indicates that promotions are a frequently used strategy to influence shopper product selection and are effective at increasing sales but the healthiness of promoted versus non-promoted breakfast items does not vary greatly. Conclusion: Marketing strategies focusing on promoting healthier products only could be an important means to improve the healthiness of supermarket food purchases and thus population diets and health.

J. Soares Guimaraes, E. Pauze, M. Potvin-Kent, S. Barquera, A. Jauregui, G. Sacks, L. Vanderlee, D. Hammond. The relationship between parent’s self-reported exposure to food marketing and child and parental behavioural outcomes: Findings from the International Food Policy Study.

Research has shown the relationship between food advertising and children’s food intake, and the influence of food marketing on parental choices and purchase intent. The objective of this study was to assess the relationship between parent’s self-reported exposure to unhealthy food marketing and children’s ownership of fast-food toys; child request and parental purchasing of unhealthy food with characters; and children’s intake of unhealthy food and beverages; and whether these behavioral outcomes varied by country. Data from the 2018 International Food Policy Study (IFPS). Respondents included parents with children under 18 years old, from Australia, Canada, Mexico, the United Kingdom, and the United States. Binary logistic and generalized ordinal regressions were used to evaluate the association between exposure, country and the behavioral outcomes. Overall, 56.0% of parents reported being exposed to food marketing in traditional media, followed by 45.5% in digital media. Over half of parents (55.3%) reported child ownership of toys from fast-food companies. Mexican parents reported the highest proportions of ownership of fast-food toys, child requests and parental purchases of food products with characters. Exposure to unhealthy food marketing was positively associated with all behavioral outcomes, and with higher probability of consumption of dessert and candy. Mexico showed lower odds for all behavioral outcomes but showed higher odds for consumption of unhealthy foods and beverages. In conclusion, parent’s exposure to unhealthy food marketing is positively associated with children’s consumption of unhealthy food and beverages and with child request of unhealthy foods with licensed and spokes-characters.

S. Srebot, M. Ahmed, J. Lee, M. L’Abbe. Comparing the prevalence and nutritional quality of plant-based meat and dairy alternatives to meat and dairy products in the Canadian food supply.

Although plant-based alternatives are growing in popularity in Canada and in 2019, Canada’s Food Guide recommended Canadians “Choose protein foods that come from plants more often.”, little is known about the prevalence and nutritional composition of such protein foods. The objective of this study was to compare the prevalence and nutritional quality of plant-based meat and dairy alternatives with respective meat or dairy products. Using the University of Toronto Food Label Information Program (FLIP) 2020, a database of nationally representative packaged foods, a sample of foods and beverages sold at a leading grocery store in Canada (Loblaws Inc.) was used (n=9,429). Using Health Canada’s Tables of References Amount food categories, prevalence was determined by calculating the proportion of plant-based meat and dairy alternatives in the meat and dairy categories, respectively. Nutritional quality was examined by comparing the calories and nutrient levels between animal- and plant-based products. Plant-based meat and dairy alternatives accounted for 10.92% and 14.1% of foods within the respective categories. Out of 1232 plant-based products examined, dairy and meat alternatives were lower in total and saturated fat, cholesterol, sodium, and protein compared to their respective animal-based products, while being higher in iron and carbohydrates. Dairy alternatives were lower in total energy, calcium, and vitamin A. Meat alternatives were higher in total energy, sugar, calcium, and fibre. Overall, plant-based meat and dairy alternatives have a low prevalence in the Canadian packaged food supply with different nutritional profiles than the respective animal-based products.

L. Vanderlee. Food-EPI Canada: Evaluating food environment policies in 2017 and plans for future research.

The current food environment in Canada makes it hard for Canadians to make healthy food choices. In 2017, the Healthy Food Environment Policy Index (Food-EPI) was employed in Canada to assess food environment policies at the national and subnational (provincial and territorial) level. Food environment experts from across Canada convened in three workshops to analyze policy implementation in Canada across policy areas, including: food composition and formulation; food labelling; food promotion and marketing; food prices and taxation; food and nutrition standards; food retail and zoning; and trade and investment policy. This presentation will share results from this research process, and will characterize the implementation of food environment policies in Canada in 2017 and the priority action areas that experts identified as highly important and achievable for governments to implement that would – if implemented effectively – have the greatest impact on the food environment. The presentation will also describe the dissemination of the results to policy stakeholders following the completion of the research process, and uptake of the results in the Canadian context. Finally, future research to be conducted in Canada and plans for ongoing implementation of the public sector module as part of INFORMAS Canada will be discussed.

M. Warken, T. Sanden, N. Shanks, R. Engler-Stringer, H. Vatanparast.  A contradicting reality – unhealthy food environments in publicly funded facilities that support wellness.

Introduction: The impact of food environments (FEs) on eating behaviours is gaining recognition as population health outcomes continue to deteriorate. As a preferred gathering place, FEs in public recreation facilities (PRFs) have been of particular interest as they also have a priority to support wellness. Some jurisdictions have described the food and beverage options available as unhealthy and unsupportive of health, which contradicts this priority. One study found that children and youth involved with sports consumed more calories, fast food and sugary beverages than those who do not. Objective: To characterize the current state of food environments in PRFs in Saskatchewan (SK), Canada. Methods: We use a convergent/parallel mixed methods study design. The quantitative component included Nutrition Environment Measures Survey-Restaurant reduced item (rNEMS-R) and Nutrition Environment Measures-Vending (NEMS-V) observational audits to determine the healthfulness of food and beverage options in concessions and vending (Study I), and the qualitative component included semi-structured telephone interviews to examine barriers, facilitators and future opportunities in SK (Study II). Results: Quantitative results confirmed that only 5% of concession main dishes were defined as healthy. As well, 80% of packaged food and beverage products in concessions, and 84% in vending, were defined as Offer Least Often (Saskatchewan Nutrition Standards, 2018). Qualitatively, barriers far exceeded facilitators for healthy eating. Some key barriers included a lack of policy, guidelines, resources, capacity, funding, infrastructure, incentives, direction, availability and promotion of healthier options as well as economic risk. In turn, several future opportunities emerged, which relate to the aforementioned barriers, such as the need for policy, guidelines, incentives and direction. In addition, there is a need for healthy food access and promotion, stakeholder engagement and knowledge exchange platforms. Conclusion: Food and beverages are frequently available through concessions and vending in SK PRFs, and the options available are less healthy and unsupportive of health. Even though there appears to be organizational readiness to change, several barriers exist that are prohibiting change.

H.Y. Yang, M. Ahmed, M. L’Abbe. Development of an INFORMAS composition module and database to monitor the nutritional composition of chain restaurant foods.

Although restaurants make up over 20% of our calories, most menu items are of poor nutritional quality. Restaurants are exempted from nutritional labelling, which is mandatory for prepackaged foods. In 2017, the Healthy Menu Choices Act mandated food service establishments with ≥20 outlets in Ontario to display calories on menus, but not the complete nutrient information. This study aims to update the Menu-FLIP database to monitor nutritional composition of chain restaurant menu items. Published restaurant directory and market share reports were used to identify top Canadian restaurants by number (n=506). Websites of restaurants were checked to identify chain restaurants with ≥20 outlets nationally in 2020 (n=201). Data including size and nutritional information were extracted into the Menu-FLIP database and items were categorized into major (e.g. entrée) and sub-categories (e.g. entrée–burger). Of the 201 eligible chain restaurants, 141 (70%) provided nutritional information. All 141 restaurants listed calories, with 119 (84%) provided nutrient of concerns (saturated fat, total sugar, sodium) and 70 (50%) provided data on 13 nutrients listed on the Nutrition Facts table. Serving size weight was provided in 60% of restaurants. Most chain restaurants provided publicly available nutritional information but only half of them provided complete nutrient profiles. Not reporting serving size could potentially encourage serving size framing. The lack of comprehensive data challenges the assessment and monitorization of the nutritional quality of restaurant foods and their potential impact on consumption and health. Future polices in nutrition reporting by restaurants are needed to increase transparency for researchers and consumers.

L. Young, Y. Tang, K. Bradbury. Sugar content of yoghurt in New Zealand.

Introduction: High sugar intake is associated with poor health. Lower fat yoghurt, from the milk and milk products food group, is recommended within a healthy diet, yet many may contain added sugar. Aim: This study aimed to determine the total sugar content of yoghurts, the proportion that met the voluntary Heart Foundation (HF) target (8.5 g/100g), mean Health Star Rating (HSR) score and relationship between total sugar and total fat content. Method: Information on the nutritional composition of the ‘Yoghurt and Yoghurt drinks’ category (n=346 products) was extracted from the 2019 Nutritrack database, an annual survey of NZ supermarket packaged food and beverages. Product data were linked to Nielsen Homescan®, which provides information on household food and beverage purchases from a representative sample of NZ households. Results: In 2019, the median (interquartile range) sugar content of all yoghurt products was 8.9 (5.7, 11.2) g/100g, and 46.8% (n=162) of yoghurt products met the HF sugar target. The median sugar content by total units and total weight purchased was higher, at 9.7 (6.9, 11.3) g/100g and 9.7 (7.8, 11.2) g/100g respectively. The overall median HSR score of yoghurts was 3.5 (2.5, 4). There was no significant difference in the sugar content of low-fat and regular-fat yoghurts. Conclusion: Just under half of the yoghurts available in major NZ supermarkets in 2019 met the HF sugar target. A government-led reformulation programme would encourage the food industry to further reduce the sugar added to yoghurts along with other high-sugar packaged foods and beverages.

M. Amini, D. Ghodsi, A. Zargaraan. Monitoring food promotion to children in Iran mass media: Modification of INFORMAS protocol.

Introduction: For systematic and consistent data collection and analysis, the International Network for Food and Obesity/NCDs Research, Monitoring and Action Support (INFORMAS) have developed a protocol. Although the protocol has detailed the relevant methods, it does not entirely fulfill our needs in the context of Iran. The present study aimed to modify the INFORMAS protocol to be used as a reliable tool for analyzing the content of TV, radio, and billboards in Iran. Methods: The original protocol, FOOD PROMOTION MODULE, Food marketing-Television, was translated to Farsi. Since the protocol is mainly developed for television, it was needed to be adjusted to cover radio and billboards data, as well. The revised protocols were evaluated by a panel of experts. Findings: Three protocols for data collection and analysis for Television, radio, and billboards were developed. For nutrient profiling of the advertised products, in addition to food category coding of INFORMAS and WHO EU Nutrient Profiling System, article 37 of the Fifth Development Plan of the Islamic Republic of Iran (2011-2015) in which a list of unhealthy food products banned for advertising in the country was applied. In addition, the variable “appeals” was added to all three protocols. Further, the “program category” was modified to be used for coding advertisements in Iran’s TV, radio, and billboards. For the radio protocol, three items, including Cartoon/Company-owned character, Licenced character, and Celebrity were deleted. In billboards’ protocol, Location was added and variable 7, “Day” was deleted. Conclusion: The modified protocols in this study can serve to produce data that will be consistent and comparable between countries, regions, and different time points.

M. Babashahi, N. Omidvar, H. Joulaei, A. Zargaraan, R. Kelishadi. The food environment in and around primary schools in Iran: challenges and recommendations.

Introduction: School food environment plays an important role in shaping students’ health and nutrition behaviours and has been defined as one of the main settings for implementing policies to prevent childhood obesity and subsequent non-communicable diseases. This study aimed to assess the food environment in and around primary schools in Tehran, as one of the most populated provinces in Iran in order to analyze existing policies achievements and gaps. Methods: This cross-sectional study was performed using a mixed-method approach. Healthy School Canteen (HSC) policy, as the main policy on school food environment in Iran was analyzed through documents review, semi-structured interviews with key informants, and direct observation of schools. Through the observations, food items available in 64 canteens of primary schools in Tehran province were recorded and their nutrient content were evaluated using the nutrition facts on their packages. The number and proportion of foods that met the criteria based on HSC guideline, as well as the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined. Also, to evaluate food environment around the same primary schools (within a 500-meter buffer), the proportion of packaged processed/ultra-processed foods with child-oriented marketing attributes in 239 food stores were observed and recorded. Data were evaluated against the WHO-EMR nutrient profiling model. Also, the compliance level of food advertising around the schools was evaluated through comparing them with the list of health-threatening foods which their advertising are banned, as well as the WHO-EMR model. Results: The findings showed that a large proportion of available foods in the school canteens did not comply with the national guideline (54.7±2.54%) and WHO-EMR model (85.6±2.34%). The main reasons behind the incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, poor monitoring, high price of healthy foods, lack of scientific criteria for food categorization, and conflict of interest among the actors. Among food products marketed to children in the food stores around schools via their packaging, 93.9% were not in concordance with WHO EMR’s criteria. The difference between the national guideline and the WHO-EMR criteria was an issue. While 71.1% of food advertisings around schools were permitted items according to the national lists, the majority of them (84.6%) did not meet the WHO-EMR nutritional standards. Discussion and conclusion: There are relatively poor implementation of present policies regarding food environment in or around the schools and food advertisements outdoor zones of schools. Iran HSC policy needs to be improved through strengthening its content and monitoring structure, and by promoting community participation and active interaction between all key actors.

C. Burgaz. Effectiveness of food policies and interventions on nutrition, the environment and inequalities.

Background: As by 2050 the global population will be close to 10 billion, a pressing question is how to act at policy level to meet the demand for nutritious food, providing healthy and accessible diets for all, without impairing biodiversity, natural sources and the environment.  Methods: This scoping review aims to identify the effectiveness of food policies or interventions on nutritional, environmental and equity outcomes. In July 2021, a literature search was conducted using four academic database. From the resulting reviews, a preliminary title and abstract screening was performed, followed by an initial extraction of key information (publication year, policy subdomains, outcomes). Results: The 232 full-text reviews filtered by title and abstract screening to be assessed for eligibility were selected out of a total of 9,215. A 63% (n=148) of the reviews assessing the effect of food policies or interventions on nutrition, environmental sustainability or equity were published within the last five years. A vast majority of them (n=162) focused on food production, provision, prices, composition or food environments in general. Within supply chains, the main outcome studied is undernutrition, present in 38 out of 73 reviews, followed by environmental sustainability; for food environments, overnutrition represents the main focus, assessed in 91 out of 158 reviews. Conclusions:  Current evidence available is limited across policy interventions. The initial data extracted indicates a need for more systemic, accurate and evidence-based policy evaluations, especially within food handling, loss/waste, trade and labelling.

S. K. Djojosoeparto, C.B.M. Kamphuis, S. Vandevijvere, C. Murrin, I. Stanley, P. Romaniuk, J.M. Harrington, M.P. Poelman. Strength of EU-level food environment policies and priority recommendations to create healthy food environments.

Introduction: Food environments have an important impact on population diets, obesity and non-communicable diseases (NCDs). Government policies are essential to create healthy food environments. Currently, it is largely unknown to what extent the EU has implemented policies that affect food environments. Methods: The Healthy Food Environment Policy Index (Food-EPI), including 26 policy indicators and 24 infrastructure support indicators, was applied. Independent experts (n=31) rated the strength of EU-level policies and infrastructure support for each of these indicators (on a 5-point scale, from very weak to very strong) and identified and prioritised actions to improve food environments. Results: 65% of the policy indicators were rated weak and 23% very weak. 63% of the infrastructure support indicators were rated moderate and 33% weak. The experts recommended 18 policy and 19 infrastructure support actions to the EU. Priority recommendations included, for example, setting mandatory food composition targets and developing a high-level NCDs Prevention Strategy. Discussion: The weakness of EU-level policies might, for example, be related to the competences of the EU with regard to food environment policies or the influential strategies of the food industry. With the Farm to Fork actions key aspects of the food environment are addressed, but not as comprehensive as the actions recommended by experts in this study. Conclusion: There is large potential to strengthen EU-level policies and infrastructure support to improve food environments. Recommended actions should be implemented by the EU to create healthy food environments and reduce overweight, obesity and diet-related chronic diseases in EU Member States.

D. Ghodsi, F. Mohammadi-Nasrabadi, A. Haghighian Roudsari, M-R. Khoshfetrat, M. Babapoor, F. Esfarjani, M. Ajami, A. Zargaran. Sugar-sweetened beverages expenditure patterns in Iran after tax revenue: implications for policy implementation.

Introduction: Sugar-sweetened beverages (SSBs) are one of the largest sources of added sugar and risk factors of obesity and diabetes. This study aimed to evaluate the effect of fiscal policies in reducing household expenditure on carbonated soft drinks in Iran over the last decade. Methods: Data were gathered through reviewing on fiscal policies on SSBs in Iran, as well as secondary data analysis. All regulatory measures, documents and master plans, including constitution, the development plans, overall health policies and approvals from the high council of health and food security, and subsidy and taxes regarding the trade and marketing of SSBs in Iran were collected. Also, secondary data regarding the price of SSBs and household consumption and expenditure on carbonated soft drinks during the last decade were collected from household income-expenditure survey (HIES) obtained from Statistical center of Iran, Central bank, Consumers & Producers Protection Organization as the organization responsible for the pricing of basic goods, and Ministry of Health and Medical Education (MOHME). Results: Taxation on health threatening products in Iran started since the third development plan (2000 to 2004) and imposed a 15% tax on carbonated beverages; however, it was not implemented due to administrative problems. According to the Article 37 of Iran fifth 5-Years Development Plan (2011-2015), the list of health-related harmful goods and the percentage of taxes assigned should be determined by MOHME. Based on the Budget Law of 2013-2017, the government is obliged to receive the tax revenue for 15% increase in the price of domestically produced carbonated sugar sweetened soft drinks and 20% increase in the price of imported carbonated soft drinks. The actual price increased during the studied years and deflated price index trend showed gradual decrease from 2011 to 2016 which sharply increased in 2017. The household expenditure data demonstrated that the average per capita household expenses on carbonated soft drinks increased sharply in rural and urban households from 2006 to 2013 and after that, simultaneously with starting the tax law implementation, the trend slightly increased. Discussion and Conclusion: Effective prevention of NCDs and other diseases related to excess consumption of SSBs depends on the proper policies. Based on the findings, it can be suggested that government should choose both health promotion (promoting healthy behavior) and health protection (protecting the population against health dangers) in order to get the best result.

D. Ghodsi, R. Roustaee, A. Faramarzi, N. Omidvar. Price of healthy and un-healthy foods before and after COVID-19 in Iran.

Introduction: Food price has been implicated in promoting healthy or unhealthy food choices, household expenditure, and influencing the diet and health of individuals. COVID-19 induced lock down has disrupted the food markets and commodity prices. This study aims to investigate the changes of the price of healthy and less healthy foods before and after COVID-19 epidemic in Iran.
Methods: Data on household income-expenditure survey (HIES) and Consumer Price Index (CPI) were obtained from the Iranian Statistical Center reports for the period of 2018-2019. The mean annual price of foods and beverages consumed by households were extracted or calculated from the HIES. Foods and beverages were classified to healthy and un-healthy following WHO-EU Nutrient Profiling System and the list of health-threatening foods based on article 37 of the Fifth Development Plan of the Islamic Republic of Iran (2011-2015). The NOVA classification system was also employed to classify foods and beverages into unprocessed/minimally processed, processed and ultra-processed. INFORMAS food price module was used and the prices were reported based on 100 gram of edible portion.
Results: The increase in prices of healthy and unhealthy foods and beverages, and all food groups were seen from 2018 to 2020. The price of healthy foods was less than unhealthy ones. The trend of increasing food prices after COVID-19 was similar for healthier and un-healthy foods. In contrast, with NOVA classification unprocessed or minimally processed foods were the most expensive groups over time followed by processed foods. The trend of increase was similar for unprocessed and ultra-processed foods and healthy and unhealthy foods. Among the unprocessed food groups, per 100 gram edible portion of nuts and all kind of meats were the most expensive groups before and after COVID-19 (153306 vs. 76381 IRR/100gr, and 67498 vs. 36090 IRR/100gr, respectively) and fruits and cereals and grains had the lowest price (7383 vs. 15391 IRR/100gr and 7437 vs. 15646 IRR/100gr, respectively). The percent change in CPI for food and beverage groups (inflation rate of the household) from 2018 to 2020 was 36.6, 42.4, and 38.7, respectively (considering 2016 as reference year).
Discussion and Conclusion: Food prices in Iran have changed unfavorably during the study period. Unfortunately, the price of unhealthy foods is lower than healthier one, which affects the food choice of the households and could affect their health status. Factors related to the pandemic along with other factors such as the high inflation rate and the political condition prevailing in society are effective increasing food prices. Government is trying to keep food prices stable and ensuring food security by orderly pricing, importing and subsidies on some foods.

C. Gréa, S. Roser, S. Storcksdieck, G. Bonsmann, I. Hoffman. Monitoring the nutrient content of processed food – design of the German product monitoring.

Introduction: To follow international efforts to reduce sugar, salt, fat, and energy content in processed food, an overview of the nutrient content of nationally available packaged food is essential. This may be achieved by a regular product monitoring as conducted in Germany. Methods & Results: German product monitoring started in 2016 and 2018 with a market overview on the sugar, salt, fat and energy content of 19 product groups. Since 2019 it is continued as an annual monitoring of selected food groups. This monitoring follows a standard operation procedure, including amongst others: selection criteria of monitored food groups, e.g. frequently consumed food or significant sources in the diet for one or more of the monitored nutrients; regular monitoring interval (2-3 years) for the same food group; collection of data (packaging information) predominantly online; subdivision of food groups according to official guidelines and experts’ consultation; application of criteria to identify processed foods targeting children, separate analyses of their composition. Data management is done with FoodCASE. Data analysis of (sub)food groups considers the wide range of processed food available as well as their market share. Discussion & Conclusion: Product monitoring has proven to be an important instrument to accompany the National Reduction and Innovation Strategy for Sugar, Fats and Salts in Germany. It reveals developments (e.g. sugar reductions in yoghurt) and further need for action (e.g. foods
targeting children).

Ž. Lavriša, N. Zupanič, M. Hribar, K. Žmitek, A. Kušar, I Pravst. Sales and sugar content in non-alcoholic beverages between 2011 and 2019 in Slovenia.

Sugar-sweetened beverages (SSBs) remain one of the largest dietary sources of free sugars in Slovenia. They have little to no nutritional value and have been linked to several adverse health effects, such as weight gain, increased risk of type 2 diabetes, and other cardiometabolic diseases. In 2015, Slovenian soft drink industry made a voluntary liability commitment to reduce the amount of sugars in SSBs. The aim of this study was to analyse the trends in free sugar content of SSBs available on the Slovenian market combined with the purchasing trends to further assess the effectiveness of current strategy in practice. Nutrient profiles of 1,468 unique bottled beverages were paired with the nation-wide 2011, 2013, 2015, 2017, and 2019 volume sales data. Between 2011 and 2019 sales of bottled beverages decreased, with the largest decrease observed among flavoured waters (-57%), ice tea drinks (-49%), and nectars (-44%). The average sugar content in SSBs on the market decreased among energy drinks (from 11.8 g/100 mL to 6.8 g/100 mL), cola drinks (from 8.8 g/100 mL to 6.4 g/100 mL), and ice tea drinks (from 7.1 g/100 mL to 6.7 g/100 mL). Average sugar content in flavoured waters and other soft drinks remained unchanged. Sales-weighted results showed that consumers tend to buy sweeter-than-average products in all analysed categories but flavoured waters, making the current strategy to reduce free sugar consumption of limited efficiency.

C. Leydon, J. Harrington. Policies for tackling obesity and creating healthier food environments in Ireland: Experts’ evaluation and prioritized actions.

Introduction: Effective government policies are essential to increase food environments’ healthiness and reduce obesity and NCDs. Many countries, including Ireland have implemented policy actions to address this priority. Monitoring the degree of implementation of policies and mapping their interaction across the food system is an important part of ensuring progress towards healthier food environments. Methods: This study evaluated the current food environment policies in Ireland using the INFORMAS Healthy Food Environment Policy Index (Food-EPI) framework. Experts rated government implementation against international best practice indicators of food environment policy and infrastructure support. The experts identified and prioritized actions based on the ratings. Results: The Irish government level of implementation compared to best practice was rated as high (13.3%), moderate to low (77.8%), or very little/none (8.9%) across the 45 indicators. Experts recommended that nutrition standards be implemented for all schools, along with establishing a committee to monitor the implementation of nutrition policies and ensure procedural transparency. Discussion: There was high levels of implementation in restricting unhealthy food promotion to children in broadcasting and monitoring obesity and NCD rick-factors. There was very little implementation in the establishment of food composition targets for out-of-home meals or zoning laws to encourage healthy food outlets. Conclusion: For the first time, a benchmarking of Irish food policies against international best practice has been conducted. It has highlighted areas for potential Government action to improve the Irish food environment.

S. O’Mahony, N. Collins, G. Doyle, E.R. Gibney. Investigating the healthiness of supermarkets in Ireland: A pilot study.

Food environments are an important component of an individual’s food choice and access to healthy foods.(1) Supermarkets are a major actor in the local food system with the amount of food purchased from supermarkets increasing.(2,3) There is also growing evidence that supermarkets influence dietary behaviours.(4) The aim of this pilot study was to investigate the availability of healthy and unhealthy food in supermarkets in areas of high and low deprivation in Dublin, Ireland. The INFORMAS Food Retail Module: Food Availability in Supermarkets Protocol was applied in a supermarket in an area high and an area of low deprivation in Dublin, Ireland, in May 2021. Shelf height (cm) and length (cm) were measured for seven food categories.(5) Shelf space for healthy and unhealthy food categories, as defined by the protocol, was weighted based on shelf location prominence (e.g. end of aisle, at checkout) using the GoPromo weightings.(6) The ratio of available healthy to unhealthy food was calculated. The pilot study found four times more unhealthy food to healthy food (unhealthy:healthy – 4:1) available in areas of low deprivation and nine times more unhealthy food to healthy food (unhealthy:healthy – 9:1) available in areas of high deprivation. In comparison there was more than double the ratio (9:1 v 4:1) of unhealthy to healthy foods in areas of high deprivation compared to areas of low deprivation. The pilot study findings indicate that there is substantially more unhealthy food available in supermarkets in areas of high deprivation in Dublin, Ireland. This finding warrants further investigation.

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2. Pulker CE, Trapp GSA, Scott JA, Pollard CM. What are the position and power of supermarkets in the Australian food system, and the implications for public health? A systematic scoping review. Obesity Reviews. 2018;19(2):198-218.
3. Hawkes C. Sales promotions and food consumption. Nutr Rev. 2009;67(6):333-342.
4. Glanz K, Bader MD, Iyer S. Retail grocery store marketing strategies and obesity: an integrative review. Am J Prev Med. 2012;42(5):503-512.
5. Ni Mhurchu C, Vandevijvere S, Waterlander W, et al. Monitoring the availability of healthy and unhealthy foods and non-alcoholic beverages in community and consumer retail food environments globally. Obes Rev. 2013;14 Suppl 1:108-119.
6. Kerr J, Sallis JF, Bromby E, Glanz K. Assessing reliability and validity of the GroPromo audit tool for evaluation of grocery store marketing and promotional environments. J Nutr Educ Behav. 2012;44(6):597-603.

L. O’Meara, C. Turner, D. Costa Coitinho, S. Oenema. Investigating consumer experiences of food environments and food acquisition practices during the Covid-19 pandemic.

This study investigates consumer experiences of food environments and food acquisition practices during the Covid-19 pandemic, drawing from a rapid online survey of 2,015 individuals from 119 countries in April 2020. Findings reveal common global experiences related to food availability and accessibility, food prices and affordability, food acquisition practices, and food preparation and consumption. The importance of community food participation, food sharing, and resource allocation are highlighted, along with increasing awareness of healthy diets and food waste. We identify ten synergistic policy entry points to: 1) build resilient and equitable food environments resistant to stresses and shocks; 2) harness positive dietary-related behaviors manifested during the pandemic; and, 3) mitigate the projected nutrition crisis and promote sustainable healthy diets for all.

E. Pineda, F. Sassi, J. Bascunan. Effectiveness of school food environment interventions for the prevention of childhood obesity: A systematic review and meta-analysis.

Introduction: The food environment has a significant influence on dietary choices, and interventions designed to modify the food environment could contribute to the prevention of childhood obesity. Many interventions have been implemented at the school level, but effectiveness in addressing childhood obesity remains unclear. Methods: We undertook a systematic review, a meta-analysis, and meta-regression analyses to assess the effectiveness of interventions on the food environment within and around schools to improve dietary intake and prevent childhood obesity. Estimates were pooled in a random-effects meta-analysis with stratification by anthropometric or dietary intake outcome. Risk of bias was formally assessed. Results & Discussion: One hundred papers were included. Interventions had a significant and meaningful effect on adiposity (body mass index [BMI] z score, standard mean difference: −0.12, 95% confidence interval: 0.15, 0.10) and fruit consumption (portions per day, standard mean difference: +0.19, 95% confidence interval: 0.16, 0.22) but not on vegetable intake. Risk of bias assessment indicated that n = 43 (81%) of non-randomized controlled studies presented a high risk of bias in the study design by not accounting for a control. Attrition bias (n = 34, 79%) and low protection of potential contamination (n = 41, 95%) presented the highest risk of bias for randomized controlled trials. Conclusions: Changes in the school food environment could improve children’s dietary behaviour and BMI, but policy actions are needed to improve surrounding school food environments to sustain healthy dietary intake and BMI.

S. Reza Sobhani, H. Eini-Zinab. Higher consumption of vegetables, fruits and dairy in the Iranian diet is a necessity to move towards a sustainable diet.

Introduction: Sustainable diets are those diets with low environmental impacts and high affordability which contribute to food and nutrition security. The present study aimed to compare the usual diet of the Iranian population with a developed sustainable food basket for Iran.
Methods: The food consumption data of 100500 households were used in this study. Linear Programming was utilized to obtain the optimal diets, separately, for each goal of the sustainable food basket including Nutrient Rich Food Index, minimum cost, minimum water footprint, and carbon footprint. The sustainable food basket was developed by considering all goals simultaneously by using Goal Programming techniques.
Results: In the sustainable diet, compared to the usual consumption, the amount of the “bread, cereal, rice, and pasta” (34%), “meat, poultry, fish, eggs, legumes, and nuts” (11%), and “fats, oils, sugars, and sweets” (24%) groups were decreased and dairy (34%), fruits (26%) and vegetable (8%) groups and cereals (38%), poultry (45%) and vegetable oil (30%) subgroups were increased. By following developed sustainable food basket, there will be a 14% reduction in the total water footprint, a 14% decrease in the total carbon footprint, a 23% decrease in the cost, and a 7% increase in NRF of diet compared to the usual consumption and it is generally 20% more sustainable. Discussion and conclusion: To achieve sustainable food consumption, policy action in the area of food and nutrition system is required to increase consumption of dairy, fruits, vegetables, and reduction in consumption of bread, rice, meat, eggs, hydrogenated fats, and sugars.

V. Smets, S. Vandevijvere. Changes in retail environments around schools over 12 years and associations with overweight and obesity among children and adolescents in Flanders, Belgium.

Introduction: Food environments influence food preferences and choices. Children have been found to be extra susceptible to the food environment. This research assessed changes in food environments near schools in Flanders between 2008 and 2020 and associations with children’s and adolescents’ weight status. Methods: The food environment within 500m and 100m road network distance to all primary- and secondary schools, as well as near university campuses was mapped using several spatial indicators. A generalized linear modelling approach was used to explore associations between these indicators and weight status of children and adolescents. Results: The food environment near schools was found to be predominantly unhealthy, with a significant increase in fast-food restaurants and convenience stores between 2008 and 2020. Food environments near schools with a higher compared to a lower percentage of students from a poor socio-economic background were less healthy, regardless of the level of urbanization. A positive correlation was found between the healthiness of food environments around primary schools and the weight status of children aged 3- 5 and aged 6-12 years. The relationship between the healthiness of food environments and the weight status of adolescents, aged 13 -18 years, was less clear. Conclusion: This research shows that the healthiness of food environments around schools is associated with younger children’s weight status. The Flemish Government therefor has a responsibility to design policies to create healthy food environments near schools to protect children’s health.

B. Thorisdottir, P.O. Eythorsdottir, D.D. Vigfusson, B.E. Birgisdottir. Food environment in Reykjavik supermarkets in Autumn of 2021.

Introduction: Supermarkets present opportunities for public health interventions. The aim of the study was to evaluate the availability of healthy and unhealthy foods in-store in the largest supermarket chains in Reykjavik capital area, Iceland. Methods: Supermarkets from four chains; A (n=3), B (n=3), C (n=3) and D (n=3) were assessed using the relevant Informas protocol with some adaptations. Measures on selected healthy foods (fresh and frozen fruit and vegetables) and selected unhealthy foods and beverages (confectionary, chips, soft drinks, sweet biscuits) were conducted from August 18th to September 16th, 2021. Measures included: (i) proportion of shelf space (m2) allocated to healthy and unhealthy foods; (ii) visibility by location. Results: For every 10 m2 of shelf space for unhealthy foods, there were on average 4.8 m2 of shelf space for healthy foods, with large variations between chains; On average: chain A=3.2 m2, chain B=2.3 m2, chain C=4.8 m2, chain D=8.9 m2. Differences between stores within chains were small. All stores had unhealthy foods at the checkout area, varying in shelf space; On average: chain A=7.3 m2, chain B=9.4 m2, chain C=9.5 m2, chain D=2.6 m2. Discussion: There are large variations in space given and visibility for healthy and unhealthy foods between supermarkets in Reykjavik capital area. This presents an opportunity for retailers to improve the healthiness of supermarkets towards best practice. The supermarkets’ managers were keen on getting feedback and open to further collaboration. Conclusion: Given the public health importance, governments could make guidelines for health promotion within supermarkets.

I. Van Dam, N. Reimes, S. Vandevijvere. Benchmarking the nutrition-related commitments and practices of major Belgian food companies.

To quantitatively assess the transparency, specificity and comprehensiveness of nutrition-related commitments and practices of the largest Belgian packaged food and non-alcoholic beverage manufacturers (n=19), supermarkets (n=5) and quick-service restaurants (n=7), the ‘Business Impact Assessment on Obesity and population-level nutrition’ (BIA-Obesity) was applied. Nutrition-related commitments and practices were evaluated concerning product formulation, labelling, promotion and accessibility. Public commitments were collected and company representatives given the opportunity to complete the information (2019-2020). To assess practices the following indicators were calculated: median Nutri-Score of portfolios, the proportion of products not-permitted to be marketed to children (WHO Regional Office for Europe nutrient profile model), the proportion of ultra-processed products (NOVA-classification) and the proportion of products displaying Nutri-Score. Supermarket flyers were analysed over a one-year period and quick-service restaurant density around schools was calculated. Correlations between commitments and performance were calculated applying the Spearman’s rank correlation coefficient. 56% of companies participated. Overall BIA-Obesity scores ranged from 2% to 75% (median=35%) with notable variation across policy domains and food industries. The proportion of portfolios consisting of A and B Nutri-Score ranged from 0% to 100% (median=29%), median portfolios were for 81% (12%-100%) not-permitted to be marketed to children and consisted for 75% (2%-100%) of ultra-processed foods. No significant correlations were observed between commitments and performance. Food industry actions did meet recommended best practices. Performance indicators show large potential for improvement across domains and industries. Government regulation is urgently needed to ensure that company commitments translate into improved practices.

S. Vandevijvere, C. Pedroni, K. De Ridder, K. Castetbon. The cost of diets according to their caloric share of ultra-processed and minimally-processed foods in Belgium.

Introduction: This study estimated the monetary cost of diets with higher and lower caloric shares of ultra-processed food products (UPF) and unprocessed/minimally processed foods (MPF) in Belgium for various sociodemographic groups. Methods: Data from the latest nationally representative Food Consumption Survey (FCS) 2014-2015 (n = 3146; 3-64 years) were used. Dietary data were collected through two nonconsecutive 24-hour recalls (food diaries for children). Average prices for >2000 food items (year 2014) were derived from GfK ConsumerScan panel data and linked with foods consumed in the FCS. Foods eaten were categorized by their extent of processing using the NOVA classification. The average caloric share (percentage of daily energy intake) of UPF and MPF were calculated. The mean diet cost was compared across the UPF and MPF contribution tertiles, using linear regression. Results: UPF contributed between 21.9% (female adults) and 29.9% (young boys), while MPF contributed between 29.5% (male adolescents) and 42.3% (female adults) to the daily dietary cost. The contribution of MPF to the daily dietary cost was significantly higher for individuals with a higher household education level compared to those with a lower household education level (p < 0.01). Adjusted for covariates, the average dietary cost per 2000 kcal was significantly lower for individuals in the highest compared to the lowest tertile for the proportion of daily energy consumed from UPF (EUR -0.37 ± 0.13; p = 0.006), and significantly higher for individuals in the highest compared to the lowest tertile for proportion of daily energy consumed from MPF (EUR 1.18 ± 0.12, p < 0.001). Conclusion: Diets with a larger caloric share of UPF were significantly cheaper than those with a lower contribution of these products, while the opposite was found for MPF. Policies that improve relative affordability and accessibility of MPF are recommended.

B. Wood, G. Sacks, O. Williams, P. Baker, V. Nagarajan. A proposed approach to monitoring the structure, conduct and performance of processed food markets and companies.

Introduction: Processed food markets can have detrimental impacts on societal welfare, including from negative externalities related to unhealthy food sales, the unjust distribution of costs and benefits, and the presence of concentrated market power. We propose a systematic approach to monitoring the structure of processed food markets, the market-related conduct of food companies from a public health perspective, and the contribution of such markets and companies to societal welfare. Methods: The Structure-Conduct-Performance model was used as an organising framework. We reviewed a range of literature to identify relevant concepts and metrics. The approach was applied to the global soft drink market. Results: ‘Structure’ metrics included those related to market concentration and common ownership. ‘Conduct’ analysis was informed by Porter’s five forces framework. ‘Performance’ metrics included those related to wealth generation and distribution. When these metrics were applied to the global soft drink market, we found that most national markets were highly concentrated and oligopolistic. Dominant soft drink manufacturers use a wide range of market strategies to increase and consolidate their power. The majority of wealth generated by these dominant firms flows to wealthy stakeholders in high-income countries. Discussion: The proposed approach could help the public health community better engage with policy discussions on addressing common market failures. In particular, the approach could be used to inform discussions of the role of competition policy in promoting healthier and more environmentally sustainable food systems.

A. Abayasekara, N. Arunatilake. Developing a retail food environment score to assess food environments in Sri Lanka’s urban underserved settlements.

Food environments that promote energy-dense, cheap, and palatable foods have been recognized as a key driver of unhealthy eating, obesity, and non-communicable diseases (NCDs). Urbanization-driven rapid changes in food environments in low- and middle-income countries has led to increased policy attention on how food environments shape population diets. But limited research is available in these settings due to the dynamic and complicated nature of food environments, lack of comprehensive data, and the wide range of food sources available. The aim of this study is to develop a food environment assessment tool to assess food retail outlets in selected urban underserved settlements in Sri Lanka, which are characterized by poor access to healthcare and healthy food and high rates of NCD prevalence. Existing methods typically assess food environments across four main indicators: food availability and variety, prices, advertising, and placement, where food environments with high availability, variety, affordability, and promotion of healthy foods are assigned higher rankings. We customize these tools to our study setting, where commonly available food items in retail outlets are ranked by healthiness based on the level of food processing in combination with Sri Lankan dietary guidelines, after which a food environment assessment score is developed around the four indicators. We pay particular attention in using the tool to support the development of fiscal and regulatory policies that can positively influence food environments along the availability, affordability, and food promotion dimensions. The tool is also used to assess how COVID-19 related restrictions have affected food environments.

R. Ambikapathi, M. Boncyk, N.S. Gunaratna, J. Kanani, L. Heniff, W. Fawzi, G. Leyna, J. Killewo, S. Kadiyala, C. Patil. Expanding the food environment framework to include family in the context of living with HIV: a qualitative evidence synthesis.

Rapid changes occurring in the food environments (FE) of low- and middle-income countries are increasing dietary risk factors for non-communicable diseases (NCDs). People living with HIV (PLHIV) and their families share these risks, but few studies explore family dynamics and food choices. This qualitative evidence synthesis (Prospero registration: CRD42021226283) assessed family dynamics in the shaping of food choices and how an HIV diagnosis and treatment relate to food acquisition, preparation, allocation, consumption, and other decisions. Keyword searches of Pubmed, Scopus, and Web of Science identified >6000 non-duplicate relevant qualitative studies. Using Colandr, a team approach for reviewer agreement on title, abstract, and two rounds of full-text screening and the Critical Appraisals Skills Program to assess quality was used. From 6039 titles, 1158 abstracts were screened and 514 continued to full-text review. A total of 108 manuscripts were reviewed, with 93% taking place in Africa and Southeast Asia. Content analysis guided by a codebook informed by Turner’s FE framework and Gidden’s structuration theory was used to identify family FE themes. Disclosure, gender differences, social network, nutrition knowledge, caregiver burden, perceived significance of food, dyadic marital relationship, and family composition were organized in a matrix linking the external and personal FEs. Including family dynamics in existing FE frameworks provides an opportunity for a robust understanding of motivations behind food choices for PLHIV and their families given the growing prevalence of NCDs. This framework expansion can help guide the structuring of nutritional policies that are effective and optimal for the whole family.

E. Borazon, M. de los Santos. Content analysis of TV food advertisements targeted to children in the Philippines.

Exposure to TV food advertisements is considered as a potential factor influencing dietary and food consumption behavior among children. However, there are no policies regulating child-targeted TV food advertisements in the Philippines. Furthermore, there is limited literature which explores the influence of TV food advertisements on the dietary health of Filipino children in which overweight and obesity are prevalent. Therefore, this study conducted an exploratory content analysis of TV food advertisements aired in most popular channels for Filipino children aged 2 to 12 (GMA, GNTV, and TV5). Data were collected from January to April 2021 through manual recording and aired advertisements were monitored using a categorical sampling design. The level of exposure of children to TV food marketing will be assessed using the frequency of which child-targeted TV food advertisements were aired. TV food marketing practices of food brands will also be evaluated based on the persuasive techniques, representations, and portrayals observed in the advertisements. The results of this study will characterize TV food advertisements in the Philippines and identify elements of child-targeted TV food marketing that influence Filipino children’s dietary behavior. Finally, the study shall provide policy recommendations which will help implement and promote responsible TV food marketing to children in the Philippines.

A. Ganpule-Rao, K.A. Brown, M. Dubey, N. Srinivasapura Venkateshmurthy, H. Pandey, P. Jarhyan, A. Prasad Maddury, R. Khatkar, D. Prabhakaran, S. Mohan. (1) Food insecurity, dietary diversity and malnutrition in North and South India / (2) Comparison of diets in North and South India with EAT Lancet diet.

(1) Introduction: Food security is a major priority for developing countries like India. However, very few studies have used standardized methods like Food and Agriculture Organization’s Food Insecurity Experience Scale (FIES) to measure it. We used FIES to measure food security and its association with nutritional and sociodemographic factors. Methods: We used FIES to measure food security in a sample of 9005 adults residing in North and South India. Socio-demographic factors, dietary diversity(IDDS-FAO) based on food frequency questionnaire, anthropometry was assessed. Results: The mean(±SD) age was 52.2(±11.6) years, 50% were women and 60% resided in rural areas. Mean FIES score was 0.21±0.76 and 6.3% (95%CI: 5.8-7.0) participants reported experience of mild, 2.2%(1.9-2.5) moderate and 1.5%(1.3-1.8), p <0.05) severe food insecurity. Dietary diversity was low as >50% participants from Sonipat and 40% from Vizag consumed only three food groups daily i.e., starchy staples, other fruits- vegetables and dairy. Consumption of nutrient rich foods like vitamin-A-C-rich fruits, vegetables and nonvegetarian foods was low. Overall, 812(9.2%) were underweight/undernourished (BMI<18.5kg/m2) and 3877(44.4%) were overweight/obese (BMI>24.9kg/m2). Women experienced higher food insecurity than men ((10.3%(9.4-11.1) Vs 9.1%(8.1-9.9), p<0.001)). In the multiple regression analysis women, those belonging to lower wealth index, residing in rural areas, and those with lower BMI and lower dietary diversity had higher food insecurity (p<0.05 for all). Conclusions: Food security is under-investigated in India. Despite low levels of food insecurity, dietary diversity was sub-optimal and malnutrition was prevalent, especially among women. Similar studies at national level are necessary to better understand food insecurity in India and plan policy actions.

(2) Background: A sustainable and healthy food system is vital for human and environmental health. The 2019 EAT-Lancet Commission report recommends diets with more plant-based and fewer animal source foods to ensure that the world’s resources can provide sufficient healthy and sustainable foods to feed 10 billion people by 2050. The aim of this study was to compare current diets in different parts of India with the EAT-Lancet recommended diet. Methods: Dietary intakes were measured using a food frequency questionnaire (24 groups) among 9,005 participants from Sonipat (north India) and Visakhapatnam (south India) during the UDAY follow up study Results: Mean age of the participants was 52.4±11.7 years, 50% were women and resided in rural areas. Compared with the Eat-Lancet diet, participants had significantly lower consumption of nutrient-rich foods from good quality protein sources and vegetables although they had higher consumption of whole grains and starchy foods (p<0.05All). These dietary gaps were higher for the rural and poorest households (p<0.001Both). Of the high carbon foot print foods, red meat and nonvegetarian foods (meat, fish, poultry) were less frequently consumed in Visakhapatnam, and over 80% participants in Sonipat were vegetarian; however, dairy foods were consumed adequately. Fruit consumption was comparable to EAT- Lancet recommendations. Conclusions: Participants’ diets lacked quality. Increasing consumption of protein sources and vegetables through public interventions and initiating policy actions for making these foods available, affordable and acceptable for all is essential. Adaptability of Eat Lancet recommendations needs to be studied in context of diverse Indian consumption patterns.

G. Hafeeza Begum Abdul Rahim, T. Thoradeniya, C. Arambepola. The health relatedness of labelling of foods and non-alcoholic beverages in a main supermarket in Sri Lanka.

Introduction: Unhealthy food consumption contributes to increasing obesity and non-communicable diseases. Ready to consume processed foods and non-alcoholic beverages (FNB) are energy-dense and nutrient-poor, thus play an important role in this regard. This study was carried out to assess the health relatedness of labelling of FNB commonly sold in Sri Lanka. Methods: Labels of FNB purchased (n = 149) from a selected outlet of a leading supermarket chain were photographed. Health-related information on labels were analyzed using INFORMAS protocol. Products were categorized as ‘less healthy’ and ‘healthy’ using Nutrient Profiling Scoring Criterion of Food Standards Australia New Zealand. Results: Overall, 8.7% products were ‘healthy’ and 17.4% were ‘less healthy’, while 73.8% had incomplete nutrition information. Sixty five percent of products with ingredient list and nutrition information panel, 19.5% with multiple nutrition information panel and 36.2% with supplementary nutrition information were identified. Out of 500 total claims, 223 were priority nutrients and NCD related health conditions. ‘Healthy’ products displayed 8 out of 30 NCD related health claims as ineligible. Discussion and Conclusion: More ‘less healthy’ than ‘healthy’ products were among the commonly sold FNB. Healthiness of majority of products could not be assessed due to incomplete nutritional information. Quantitative ingredient list, multiple nutrition information panel, supplementary nutrition information and nutrition and health claims were poorly displayed. Our findings highlight the importance of monitoring food labelling in order to help consumers make healthier choices.

J.C.Y. Louie, L.Y. Chan, D.H. Coyle, J.H.Y. Yu. Total and free sugars level and the main types of sugars used in 18,784 local and imported pre-packaged foods and beverages sold in Hong Kong.

Introduction: There is limited information regarding the free sugar content of pre-packaged foods in Hong Kong. This study aims to assess the free sugar content and identify the most frequently used free sugar ingredients (FSI) in pre-packaged foods in Hong Kong. Methods: Data of 18,784 products from the 2019 FoodSwitch Hong Kong database were used in this analysis. Ingredient lists were screened to identify FSI. Total sugar content was derived from nutrition labels on pack. Free sugar content was estimated based on adaptation of a previously established systematic methodology. Descriptive statistics of the total sugar and free sugar content, as well as the mean ± SD contribution of free sugar to total sugar of the audited products were calculated, stratified by food groups. Results: Almost two-thirds (64.5%) of the pre-packaged foods contained at least one FSI. ‘Sugar (sucrose)’ was the most popular FSI that was found in more than half (54.7%) of the products. ‘Fruit and vegetable juices’ (median 10.0; IQR 8.3-11.5 g/100 mL) were found to have a higher median free sugar content than ‘Soft drinks’ (8.0; 6.0-10.6 g/100 mL). Mean ± SD contribution of free sugar to the total sugar content was 65.8 ± 43.4%, with 10 8 out of 16 14 food groups having >70% total sugar as free sugar. Discussion/Conclusion: Free sugar, especially sucrose, was extensively used in a wide variety of pre-packaged products sold in Hong Kong. Further studies are needed to assess the population intake of free sugar in Hong Kong to inform public health policy on free sugar reduction.

J.C.Y. Louie, T. Davies, R. Ndanuko, S. Barbieri, O. Perez-Concha, J.H.Y. Yu. A machine learning approach to predict the added sugar content of packaged foods.

Introduction: Dietary guidelines recommend limiting the intake of added sugars. However, despite the public health importance, most countries have not mandated the labeling of added sugar content on packaged foods and beverages, making it difficult for consumers to avoid products with added sugar, and limiting the ability of policymakers to identify priority products for intervention. This study aimed to develop a machine learning approach for the prediction of added sugar content in packaged products using available nutrient, ingredient, and food category information. Methods: The added sugar prediction algorithm was developed using k-Nearest Neighbors (KNN) and packaged food information from the US Label Insight dataset (n = 70,522). A synthetic dataset of Australian packaged products (n = 500) was used to assess validity and generalization. Performance metrics included the coefficient of determination (R2), mean absolute error (MAE), and Spearman rank correlation (ρ). To benchmark the KNN approach, the KNN approach was compared to an existing added sugar prediction approach that relies on a series of manual steps. Results: Compared to the existing added sugar prediction approach, the KNN approach was similarly apt at explaining variation in added sugar content (R2 = 0.96 vs. 0.97 respectively) and ranking products from highest to lowest in added sugar content (ρ = 0.91 vs. 0.93 respectively), while less apt at minimizing absolute deviations between predicted and true values (MAE = 1.68 g vs. 1.26 g per 100 g or 100 mL respectively). Discussion and Conclusions: KNN can be used to predict added sugar content in packaged products with a high degree of validity. Being automated, KNN can easily be applied to large datasets. Such predicted added sugar levels can be used to monitor the food supply and inform interventions aimed at reducing added sugar intake.

W. Ng See Hoe, G. Sacks, B. Kelly, H. Yeatman, E. Robinson, B. Swinburn, S. Vandevijvere, K. Chinna, M.N. Ismail, T. Karupaiah. Reflections on applying the BIA-Obesity tool to assess population nutrition commitments of food industry in Malaysia.

The food industry has a critical role in shaping population diets. Benchmarking the nutrition-related policies and commitments of major food companies can assist in understanding the effectiveness of the regulatory landscape and increasing accountability for action. This study aimed to reflect on the process of assessing the policies and commitments of major food companies in Malaysia using the Business Impact Assessment-Obesity (BIA-Obesity) tool developed by INFORMAS with local modifications. We assessed 22 food and beverage manufacturers, 5 fast food companies and 6 retailers. Only 6 companies (18%) agreed to engage in the assessment process. For the remaining companies, evidence was gathered through document analysis and product surveys, with the latter complementing the lack of online policy information (e.g. nutrition labelling). For the first time, we involved a panel of public health experts in scoring companies using the BIA-obesity tool. This was designed to increase confidence in the final results. We found limited company commitments to population nutrition, with most companies lacking comprehensive, specific and transparent information regarding product reformulation, labelling and promotion. Findings were disseminated first to all industry stakeholders (n=18 companies represented), and then via a public forum (over 40 attendees) to government, non-government organisations, academia and media representatives. Positive feedback received included considering implementation for some recommendations (industry) and strengthening industry engagement to support healthy population diets (government). The study confirmed the applicability and feasibility of implementing the BIA-Obesity tool and process in Malaysia, which could serve to guide similar assessments in other low- and middle-income settings.

R. Ong Gild, W. Ng See Hoe, S. Mohd Jamil, S. Mackay, B. Kelly, B. Swinburn, T. Karupaiah. What’s advertised on children’s popular television channels during the Covid-19 period? Nutritional characteristics of food and non-alcoholic beverages in Malaysia.

With prolonged lockdowns during the Covid-19 period, Malaysians spent more hours viewing television daily. As food advertising is self-regulated in Malaysia, its effectiveness to control unhealthy food advertising to children is uncertain, with increased exposure potentially influencing food choice behaviours. Thus, we aimed to assess the nutritional characteristics of advertised food and beverages targeting children during the pandemic period. Using the INFORMAS television food marketing protocol (recording 18 hours/day x 3 channels), children’s popular channels based on Nielsen television audience viewership aged <18 years were recorded in 2020. Products’ nutrient and ingredient information were retrieved from market survey and online search to determine nutritional quality. Content analysis was performed using WHO Western Pacific (WPRO) and Southeast Asia (SEARO) nutrient profiling models, with specific thresholds for energy, fat, saturated fat, trans-fat, total sugars, added sugars, non-sugar sweetener and sodium. Coding verification with other researchers ensured data accuracy. Preliminary analysis revealed that most advertised foods and beverages were categorised as ‘not permitted’ to be advertised to children, such as sugar-sweetened beverages, sweet bakery products and convenience or prepared foods. Excessive sodium content, presence of added sugar (e.g. sucrose, lactose, maltodextrin) and non-sugar sweeteners (e.g. stevia) were common issues associated with non-permitted products. Even though food marketing self-regulations have been implemented in Malaysia, unhealthy television food advertising remains prevalent in children’s popular television channels during the pandemic. These findings should inform policymakers on the urgent need to adopt a mandatory approach to protect harmful impacts of food marketing targeting children.

T. Scapin, D. Riesenberg, K. Correa, R. Kupka, F. Watson, G. Sacks, A.J. Cameron. Monitoring retail food environments in Asia and the Pacific.

Introduction: Economic development and demographic changes in the Asia and Pacific region have resulted in rapid transitions of local food systems. The overall aim of this study is to conduct a landscape analysis of retail food environments in the Asia and Pacific region, including how they impact purchasing behaviour of both parents and children. Methods: The four project phases, being developed in partnership with UNICEF East Asia and Pacific Regional Office, include: (1) an assessment of the overall food retail market using business databases; (2) a literature review to identify retail food environment structure, in-store and online marketing, and presence of local regulations; (3) an assessment of sociocultural determinants of food purchasing behaviours by exploring key-informant perspectives; and (4) discussion panels with stakeholders. Results: We report on the first two phases of this project here. Leading food retail companies, number of outlets and market share were identified for 22 countries in the region. Rapid changes over time were identified, with a rise in the number of supermarkets, hypermarkets and convenience stores, coupled with increasing online food retail. Little evidence characterising retail food environments in the region is available. A small number of policies to promote healthy food retail have been implemented. Discussion and conclusion: This project is an important basis for understanding key aspects of retail food environments in the Asia and Pacific region and what can be done to improve the healthiness of those spaces, for children in particular. Findings can be used to support advocacy and improved policies.

D. Sunimalee Pramuditha Madurawala. Political economy of fiscal policies and regulations to promote healthy diets in Sri Lanka.

Unhealthy dietary patterns are one of the leading contributing factors of escalating non-communicable disease (NCD) incidences in Sri Lanka. Economic as well as political factors contribute to creating unhealthy food habits. This ongoing study aims at examining the political economy setting of selected two fiscal and regulatory interventions and the country’s food environment. The theoretical framework of the study is based on Kingdon’s theory of agenda-setting and Campbell’s institutionalist approach. Policy development (agenda-setting) and policy implementation stages are considered in framing the research questions. The study takes a qualitative approach, and the data sources are in two forms: documents and people. The findings of the documentary sources suggest that NCDs, nutrition, and food environment have been duly recognized as important policy issues and framed well in policy documents produced by the institutes that come under the health sector. Yet many of those policy documents have not devoted adequate attention to some crucial elements of a public health policy such as funding sources and governance. In many incidents, there is no clear commitment to implement fiscal measures. In terms of institutions, the Ministry of Health plays a crucial role in developing policies to promote healthy diets in Sri Lanka. These findings highlight the need of taking a more holistic and cohesive approach in developing the policies, which aim to address the NCDs challenge and promote healthy dietary patterns in Sri Lanka.

M. Tatlow-Golden, G. Cumbers, G. Belardo, A. Nkoroi, F. Watson, E. Boyland. Unhealthy social media food marketing to children: emerging findings from the Philippines.

Introduction: Food marketing is a systemic factor that influences children’s health, by shaping preferences, purchases and eating, including in countries experiencing nutrition transition such as the Philippines. Food marketers actively promote brands and products on social media, yet few systematic analyses exist of social media food marketing in Asia. Methods: WHO Protocols for analysing digital food marketing to children were applied. Retail sales, fast food visits and social media ‘reach’ among children were triangulated to identify 20 food brands. Posts (n=1035) were extracted from brand-owned pages on children’s most popular platforms: Facebook, Instagram, YouTube. Posts were analysed to specify: (a) is this ‘permitted’ for marketing to children, per the WHO Western Pacific Region Nutrient Profiling Model?; (b) what are the marketing strategies used, and do posts appeal to children? Results: Of 1035 social media food marketing posts analysed, 99% were ‘not permitted’ for marketing to children; 72% identified as appealing to younger children, 84% to adolescents. A fifth featured Filipino sporting and media celebrities, including children. Brands promoted products as Fun; Tasty; Enjoyable; Healthy and nutritious; Promoting family love; Making celebrations special; and Supporting physical activity. Discussion/Conclusion: Social media brand marketing in the Philippines appeals to children but overwhelmingly features items ‘not permitted’ for marketing to children. This is likely to contribute to unhealthy diets in childhood and beyond. UNICEF recommends the Government of the Philippines enact, monitor, and enforce legal, comprehensive regulations to restrict such marketing. Funding and Acknowledgment: This study was commissioned by The United Nations Children’s Fund (UNICEF) Philippines Office, as part of its commitment to address problems of unhealthy diets and increasing rates of overweight and obesity amongst children. Data extracted and analysed with support of Integrative Competitive Intelligence. Technical contributions by Maria Evelyn Carpio (UNICEF Philippines Country Office) and Roland Kupka (UNICEF East Asia & Pacific Regional Office).

C. Whitton, Y.H. Min Wong, J. Lau, C. Xin Hui, A.M. Müller, T.C. Seng, R.M. van Dam, F. Müller-Riemenschneider, S.A. Rebello. Ecological momentary assessment of digital food marketing exposure in young adults: a feasibility study.

Background: Unhealthy food marketing is a likely driver of the obesity epidemic. Digital marketing forms an increasing proportion of advertising budgets, but measuring exposure to digital food marketing presents novel challenges. Thus, methods to measure population exposure are required, to enable policymakers to formulate suitable regulatory mechanisms. Objective: Evaluate the feasibility of a smartphone-based ecological momentary assessment (EMA) methodology for quantifying exposure to digital food marketing messages. Methods: Singapore residents (18-40y) were asked to upload screenshots of all sightings of online food marketing messages for seven days. Food intake and number of hours spent online were captured three times daily using behavioural surveys. Using Poisson Generalized Estimating Equations, we assessed whether study day, time, day of the week, and behavioural survey completion predicted the number of uploads provided. Results: Participants (n=95) provided a total of 1,310 uploads over the study period, 27% of which were provided on Day 1, significantly more than on other days (P<0.001). Participants completed 90% (IQR 85-95%) of behavioural surveys, with no differences in completion by study day (P=0.6). Uploads were more likely to occur in the evening (RR 1.42, 95%CI 1.11-1.82) vs. morning, and if the behavioural surveys were completed (RR 1.9, 95%CI 1.3-2.8), suggesting these surveys may have prompted screenshot uploads. Conclusions: Insights into population exposure to digital food marketing may be gathered using EMA in large-scale studies. Future studies would benefit from a short study period, and strategies to improve response rate, such as reminders.

L. Xiang, N. Lei, Y. Tang, J Cui, J. Zhang. The extent and nature of unhealthy food and beverage television advertising to children and adolescents in Beijing, China.

Objective: To comprehensively assess the extent and nature of food and beverage television advertising (F&B ads) to which children and adolescents aged 3 to18 years old are likely exposed in Beijing, China. Methods: Four weekdays and four weekend days were randomly selected over the period from October 2020 to January 2021, excluding public holidays and school holiday periods. TV ads on five most popular channels to children and adolescents were recorded 24 hours a day, for a total of 960 hours. Peak viewing time was defined as the top five-hour timeslot for children and adolescents. F&B ads were coded as per INFORMAS Food Promotion module. Results: Of the 15447 ads coded, 36.2% were F&B ads, among which 46.49% were non-permitted to market to children and adolescents according to WHO-WPRO Nutrient Profile model. The most frequently advertised F&B categories were milk drinks (12.78%), seconded by savoury snacks (11.97%) and cheese (8.48%). The most frequently used persuasive power in non-permitted F&B ads was brand benefit claims(92.70%), followed by promotional characters technique(72.50%), and the least was premium(3.5%). Non-permitted F&B ads were more likely to use brand benefit claims and premium than permitted F&B ads(P<0.05). 28.60% of non-permitted F&B ads were shown during peak viewing time. Conclusions: Chinese children and adolescents may be at a high risk of exposure to unhealthy TV F&B ads. Our findings help justify the need for regulatory actions by national authorities.


Akosua Pokua Adjei, G Amevinya, W Quarpong, A Tandoh, R Aryeetey, M Holdsworth, C Agyemang, F Zotor, ME Laar, K Mensah, P Addo, D Laryea, G Asiki, D Sellen, S Vandevijvere, A Laar. How healthy are our supermarkets? Availability of healthy and discretionary ultra-processed foods in supermarkets of selected districts of Greater Accra region, Ghana.

Introduction: Availability of unhealthy foods can influence preference, choice, purchasing, and consumption of foods linked to the development of NCDs. This study determined the healthiness of foods sold at supermarkets located in six in the Greater Accra Region of Ghana. Methods: A multistage sampling approach was used to select the districts. All supermarkets located in the six districts were eligible to participate in the study. The shelf length and breadth for all food products in-store were measured. Foods were grouped using NOVA and according to the nutrient and energy-density (energy dense if >225 kcal/100g). Descriptive analysis was performed to generate total areas occupied by the various food groups and the ratio of healthy to unhealthy foods. Results: 85% of the shelf length occupied by food in all the supermarkets was allotted to unhealthy food categories. Fresh fruits and vegetables occupied only 1.2% of the total shelf area occupied by food. 68% of food products were classified as ultra-processed foods. For every 1m² of shelf area for a healthy food, there is 6m² of shelf area for an unhealthy food. Discussion: The rise of supermarkets in Ghana, although offering access to a range of healthy options is making ultra-processed and other obesogenic foods more accessible. Conclusion: This study reveals widespread availability of unhealthy/ ultra-processed foods in supermarkets found within the selected districts.

Gideon Senyo Amevinya, W Quarpong, A Tandoh, R Aryeetey, S Vandevijvere, C Agyemang, M Holdsworth, F Zotor, ME Laar, K Mensah, P Addo, D Laryea, G Asiki, D Sellen, B Kelly, A Laar. Heavy marketing of energy-dense nutrient-poor foods around public basic schools in Greater Accra region, Ghana.

Introduction: The marketing of energy-dense nutrient-poor foods is common in obesogenic food environments, and can influence food choices. We examined the extent and nature of marketing of foods, alcoholic and non-alcoholic beverages around selected schools in Ghana’s most urbanized region – Greater Accra. Methods: Basic schools (n =200) were selected using a multi-stage sampling approach from six districts (n=6) of the Greater Accra region. This study cross-sectionally assessed outdoor advertising using the INFORMAS Outdoor Advertising Protocol. For each food advertisement, a pre-designed tool was used to collect information– including setting, type, size of advertisement, and promotional techniques used. All advertised food products were classified and assigned to three major groups: core/healthy foods, non-core/unhealthy foods and miscellaneous based on the INFORMAS food classification. Results: A total of 5,887 advertisements were identified; 42% of these advertisements were for food. Majority (48.7%) of the food advertisements were small (>A4 paper but <1.3m x 1.9m). Advertisements were prevalent at food outlets (77.9%). Overall, 70.2% of food advertisements were classified as unhealthy, 11.5% as healthy, and 14.3% as miscellaneous. Sugar-sweetened beverages (34.5%) was the most frequently promoted food product. Promotional characters were included within 13.5% (334/2469) of all food advertisements. About 8% of all food advertisements (184/2469) had premium offers. Conclusions: There is an abundance of unhealthy food advertisements around public basic schools in Greater Accra Region. Policies and actions are needed to protect pupils from such marketing practices.

Geoffrey Adebayo Asalu, W Axame, CB Letsa, A Laar, R Aryeetey. Perception and use of health-related label among households in Accra.

Background: The extant literature on consumer food labelling use in Ghana showed limited data on health-related information use (HIU) aspects of labels. Objective: Therefore, this study investigated the perception and use of health-related information on pre-packaged foods among households in Accra. Methods: A structured questionnaire assessed consumers’ (510 respondents) food label use, perceptions, understanding of health-related label information (Nutrition Facts label, food claims, ingredient lists and serving sizes) and socio-demographic variables. STATA (v.16) was used for data analysis. Results Majority of respondents perceived that health-related information on pre-packaged food products were truthful and accurate. However, approximately one-third of them use food labels in their purchase decisions. Perceived inability, shopping behavior and absence of need were reasons for non-label use. Label users consult labels mainly to ascertain product safety and less of nutrition and health reasons. In a multiple linear regression analyses the following variables: levels of education, individuals with food allergies, those who had a previous education on the use of labels, those who perceived labels are easy to understand and individuals who self-reported adequate food label understanding showed positive association with HIU. Conclusions. Though consumers had a positive perception of health-related label information usage was low. This suggests most consumers lack adequate understanding of health-related label information. Efforts towards promoting consumer use of labels are recommended.

Semira Abdelmenan Awel, HY Berhane, M Jirström, J Trenholm, A Worku, E-C Ekström, Y Berhane. The social stratification of availability, affordability, and consumption of food in families with preschoolers in Addis Ababa; the EAT Addis Study in Ethiopia.

The aim of this study was to understand the quality of diet being consumed among families in Addis Ababa, and to what extent social stratification and perceptions of availability and affordability affect healthy food consumption. Data was collected from 5467 households in a face-to-face interview with mothers/caretakers and analyzed using mixed effect logistic regression models. All family food groups, except fish were perceived to be available by more than 90% of the participants. The food groups cereals/nuts/seeds, other vegetables, and legumes were considered highly affordable (80%) and were the most consumed (>75%). Households with the least educated mothers and those in the lowest wealth quintile had the lowest perception of affordability and also consumption. Consumption of foods rich in micronutrient and animal sources were significantly higher among households with higher perceived affordability, the highest wealth quintile, and with mothers who had better education. Households in Addis Ababa were generally seen to have a monotonous diet, despite the high perceived availability of different food groups within the food environment. There is a considerable difference in consumption of nutrient-rich foods across social strata, hence the cities food policies need to account for social differences in order to improve the nutritional status of the community.

Daniel Opoku Mensah, F O Mintah; A Oteng; R Aryeetey; R Lillywhite; O Oyebode. Presented by Michael Batame. Emerging adults’ attitudes and perceptions towards ultra-processed foods, fruit and vegetable consumption in a Ghanaian university foodscape.

Background: Understanding the influences that shape food behaviours among emerging adults and their attitudes and perceptions is an essential precondition for food behaviour modification interventions. But there exists limited research on these themes among emerging adults in the SSA setting. Objectives & Methods: This study examined emerging adults’ knowledge and attitudes towards ultra-processed foods (UPFs), fruit and/or vegetable and the influences shaping their consumption among university students in urban Ghana. The study used focus group discussions in combination with dyadic interviews with best friend pairs. Verbatim transcripts were analysed thematically using NVivo 12. Results: Emerging adults have to negotiate a complex set of barriers and opportunities operating at different levels to decide to eat UPFs, fruit or vegetable. While the influence of peers, training from home, and significant others, and body image ideals encouraged some students to consume fruit and vegetable (FV), issues of affordability, availability, nutrition knowledge, perceptions and misconceptions did not favour FV consumption, as did value satiety, local and wider societal food norms. However, affordability/price, availability and preference for satiety exerted more influence on this emerging adult group in favour of cheap, energy dense foods and UPFs, as did perceptions and misconceptions. Conclusion: Emerging adults need support to make healthy food choice. Although food pricing interventions that subsidise healthy foods, especially FV may reduce some access barriers to healthy food in this emerging adult group, multi-component interventions that combine such structural level and individual level components may be more effective. But this requires research.

Hannah Y. Berhane, AW Tadesse, A Noor, S Shinde, A Worku, W Fawzi. Food environment around schools and adolescent consumption of unhealthy foods in Addis Ababa, Ethiopia.

Background: Recent studies have highlighted the importance of school food environments in shaping the diets of adolescents and its potential to address the growing concern of adolescent obesity. This study aimed to understand the school food environment and drivers for adolescents’ consumption of unhealthy foods in an urban low-income setting in Ethiopia. Methods: A mixed-methods approach was used, including a school-based survey among 1200 adolescents (10-14 years) from 20 randomly selected government schools across Addis Ababa. In each school, we profiled all vendors within a 5-minute walking radius acquiring information on the number and type of vendors along with the product type. Focus group discussions (FGDs) with adolescent groups each comprising 3 boys and 3 girls were conducted. Mixed-effect logistic regression investigated the relationship between the number of vendors around the schools and consumption of selected unhealthy food (deep-fried food and sugar-sweetened beverages). Thematic analysis was used to summarize findings from the FGDs. Results: We found that 78.6% and 54.3% of the adolescents consumed sweets and sugar-sweetened beverages(S-SSB) and deep-fried foods(DFF) at least once a week respectively. Consumption of both DFF and S-SSB was not associated with the number of vendors available around the school. However, adolescents’ awareness and perception of healthy and safe food, and financial limitations were reported to influence consumption during the FGDs. Conclusions: Reported unhealthy food consumption is high among adolescents in Addis Ababa. School-based interventions to promote access and healthy food choices among adolescents are recommended.


BACKGROUND/OBJECTIVES: Identifying dietary patterns (DPs) as a means of preventing diet-related chronic diseases among populations in low- and middle-income countries undergoing nutrition transition is important. Dietary pattern analysis using empirically derived data are useful for this purpose. METHODS: A community-based cross-sectional study was carried out among 868 adults (20 to 59 years) in Abia State, Nigeria. DPs were identified by Principal Component Analysis (PCA) based on the consumption of 10 food groups, assessed using a 7-day qualitative food frequency questionnaire. Bivariate and multivariate logistic regression analyses were used to evaluate the association between identified patterns and associated factors. RESULT: Two main DPs were identified; a traditional pattern characterized by high factor loading of starchy staples, vegetable soups/sauces, animal proteins, legumes and a mix of processed cereals and grains; and a convenience pattern with high factor loading for processed cereals, soft drinks and alcoholic beverages. High adherence to the traditional pattern was lower among larger households (>3) [AOR =0.633; 95% CI (0.429-0.934); p = 0.021]. On the other hand, high adherence to the convenience pattern was more common among females [AOR =1.586; 95% CI (1.104-2.279); p = 0.013] and older adults (AOR = 1.750; 95% CI (1.075-2.848); p = 0.024], but least common among rural participants [AOR =0.316 1.586; 95% CI (0.219-0.456); p = 0.000]. CONCLUSION: The two DPs; traditional and convenience were associated with socio-demographic variables (age, gender, household size and place of residence). This study provides valuable information for the development and maintenance of healthier dietary behavior among adults.

Morgan Boncyk, S Kimenju, R Ambikapathi, CL Patil, H De Groote, W Omondi, NS Gunaratna. Impact of the Covid-19 pandemic on food availability, prices, and consumption in rural Kenya: Variations due to agroecological zone, market access, and gender.

The COVID-19 pandemic disrupted food systems worldwide. We present qualitative research findings on the pandemic’s impact on food environments and consumption in rural Kenya. From an existing sample frame of 121 rural communities, representing Kenya’s major maize production areas, tele-focus group discussions (T-FGDs) were conducted in 12 randomly selected communities, stratified by agroecological zone (AEZ) and distance from a city (>100,000 people, indicating market access). T-FGDs of 3 men or 3 women were conducted in Kiswahili. Emerging themes were grouped by food availability, price, and consumption and stratified by AEZ, market access, and gender. Food environment changes varied by AEZ. Generally, nutritious food became less available and more expensive, and maize consumption increased in the lowlands. High price variability was reported for meat, fruits, and vegetables. Communities farther from markets reported lower availability of fish and higher bean and vegetable prices, while closer communities observed variability in food availability and price, except for maize and milk. Gender differences within the same community existed for food, availability, prices, and consumption. Men reported increased while women reported decreased vegetable consumption. We find localized variations of COVID-19 impacts among villages by AEZ and market access. Gendered differences were observed in the perception of changes and their dietary effects. Changes in food consumption illustrate the pandemic’s impacts, especially reduced nutrient-rich and increased staple food consumption, potentially increasing micronutrient deficiencies. T-FGDs provide quick insights into community experiences and can be used to evaluate future shocks.

Makoma Bopape, L Smith Taillie, T Frank, N Murukutla, T Cotter, L Majija, R Swart. South African consumers’ perceptions of front-of-package warning labels on unhealthy foods and drinks.

Warning labels are recognised as simple, easy to understand front of package food labelling system that effectively assist consumers identify unhealthy products. This labelling system has not yet been tested in South Africa. The aim of this study was to explore adult South African consumers’ perceptions of front-of-package warning labels on foods and drinks and their insights into features that could influence the effectiveness of the labels. The study was qualitative with 113 purposively selected participants divided into 12 focus groups. Five themes emerged, positive attitudes toward warning labels, perceived benefits of warning labels, perceived behavior modification, perceived beneficiaries of warning labels, and effective attributes of warning labels. Almost all participants from all socio-economic backgrounds were positive about warning labels, reporting that warning labels concisely and understandably educated them about the nutritional composition of foods. Other perceived advantages were that warning labels warn of health implications, are easily understandable and could benefit child health. Some participants anticipated that warning labels would reduce their purchases of unhealthy foods, while others thought the labels would have no effect on their purchasing habits. Participants found the warning labels attention grabbing and stated that they preferred a black triangle placed on a white background, the words “high in” and “warning” in bold and uppercase text, an exclamation mark, and an icon depicting the excessive nutrient. Warning labels may improve consumer understanding of nutrition information on packaged food and drinks and have the potential to assist South African consumers identify unhealthy food and drinks.

Julia de Bruyn, J Wesana, SW Bunting, SH Thilsted, PJ Cohen. Applying a food environment lens to understand drivers of fish intake in the African Great Lakes Region.

Introduction: The growing prominence of food environment concepts and frameworks presents opportunities to rigorously evaluate the factors influencing access to key nutritious foods within a given setting. The fishery and aquaculture sectors have potential to support healthy, sustainable diets in Africa, yet their nutritional impact relies on an understanding of current drivers of and barriers to fish intake. Methods: This systematic scoping review synthesises evidence from 33 studies in the African Great Lakes Region to examine the influence of dimensions of the food environment on fish acquisition and consumption. Results: We identified only two studies that explicitly applied a food environment framework, and none that linked policy conditions with fish intake. Economic access to fish was represented in the largest number of included studies (21 studies), followed by preferences, acceptability and desirability of fish (17 studies) and availability and physical access (14 studies). Positive perceptions of taste and low cost, relative to other animal-source foods, were drivers of fish purchases in many settings; however, limited physical and economic access were frequently identified as preventing optimal intake. In lakeside communities, fish were increasingly directed toward external markets which reduced the availability and affordability of fish for local households. Discussion and conclusions: The use of food environment frameworks to evaluate fish acquisition and consumption – within the wider diet – can provide sound evidence to guide policy and investment decisions to improve nutrition. Our review identified important knowledge gaps about seasonal and intra-household variations in fish access. Future research is also needed to evaluate interventions, including supply increases, value chain developments or behaviour change strategies, that respond to the identified constraints of cost, availability, convenience and preferences.

Christine G. Kiria Chege,  M Mbugua, K Onyango, M Lundy. Food price changes in low and middle income food environments during COVID-19 period: The COVID-19 pandemic.

The COVID-19 pandemic and governments’ measures to curb its spread have disrupted food systems and affected food environments globally. Food availably, affordability and accessibility have been disrupted. There is limited evidence of the effects of the pandemic on food environments, especially in the informal neighborhoods/slums of urban towns or cities. This study uses primary panel data, collected in December 2020 and May 2021, from vendors in low- and middle-income neighborhoods of Nairobi to assess the impact of COVID-19 and government measures to reduce spread of the disease on food environment. Recall questions were asked during the two rounds of survey to capture commodity sales and prices before COVID1-19 and during certain times of the year when the government had implemented certain measured to control spread of COVID-19, such as total lockdowns. The study specifically analyzes consumer prices for different commodities, quantities sold during COVID-19 and effects of the prices on the quantity demanded by low and middle income urban consumers in Nairobi, Kenya. Both descriptive and fixed effects models are used to assess the effects. Our findings show that prices of most fruits and vegetables increased during first lockdown and then decreased after the lockdown in both slum and non- slum areas, while prices of most fruits and vegetables increased in January 2021 after the Government lifted 2% reduction in value added tax on all goods. Fixed effects regression analysis indicated that prices of different foods such as kales, milk, eggs and Irish potatoes had a negative effect on the quantities sold by vendors per week, implying that increased prices has led to reduced consumption of nutritious food such as vegetables (kales), animal proteins (milk and eggs) and unprocessed foods (Irish potatoes). Policy recommendations are also given in the paper.

Eva-Charlotte Ekström, M Jirström, B Alsanius, H Berhane, C Turner, K Selling, S Abdelmenan, T Shifraw, A Kebede, A Worku, Y Berhane. Food availability in residential neighborhoods and family diet diversity in Addis Ababa.

Background: There is limited knowledge on the importance of urban food environments for families’ consumption of healthy foods. Objective: To evaluate the importance of residential neighborhood food environments (rNFE) for families’ consumption of healthy foods. Methods: A multistage random cluster sampling of Addis Ababa identified 233 residential neighborhoods including 5467 households. In each neighborhood, an index household was identified and all vendors within 5 minutes walking distance were assessed for the availability of 11 healthy food groups. The same food groups were used to define family diet diversity (24h recall). For analyses, rNFE availability was further categorized into lowest, middle and highest. Data on household wealth and maternal education was collected and aggerated to the neighborhood level (NL). Linear mixed models investigated the relationship between neighborhood characteristics (food availability, NL-maternal education, NL-wealth) and household characteristics (maternal education and wealth) on the outcome of family food diversity using neighborhoods as clusters. Results: On average 7.6 of the 11 food groups were available and the families consumed 4.8 food groups. Families in neighborhoods with the lowest food availability consumed 0.2 fewer food groups compared to those in the highest. The household factors had larger effects; -1.2 if mother had not completed 1st grade vs college, and -1.2 in lowest vs highest wealth quintile. Conclusions: Neighborhood food availability had a limited effect on family diet diversity. Both maternal education and household wealth appear as much more important for family diet diversity.

Agnes Erzse, P Kruger, T Rwafa-Ponela, S Abdool Karim, S Goldstein, K Hofman. Using the behaviour change wheel to identify tailored interventions to improve food environments in public primary schools in urban South Africa.

Introduction: School food environments play a vital role in child nutrition. Interventions targeting schools can be effective but must be responsive and evidence based. The aim of this study was to identify context specific interventions to improve primary school food environments in Gauteng, South Africa using the Behaviour Change Wheel (BCW). Methods: A secondary analysis of 25 interviews with public primary school staff was undertaken. We identified risk factors influencing school food environments using MAXQDA software then deductively coded these using the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Interventions were based on the NOURISHING framework and were matched to identified risk factors. Results: Findings showed that students, staff, and food providers had limited awareness of school food and beverage guidelines, and the harms of unhealthy diets (psychological capability). There was a need for increased funding, changes to food supplies, and monitoring and evaluation systems (physical opportunity). Social influences including reward culture around unhealthy foods (social opportunity) were core targets of interventions. Profit motives of food providers (reflective motivation) and preference for unhealthy foods (automatic motivation) were both identified as important barriers to healthy school food environments. We identified 21 context-specific interventions across the COM-B domains. Discussion and conclusion: Facilitators and barriers to healthy school food environments need better understanding to identify context specific interventions that modify school food environments and allow students to make healthier food choices. The BCW and COM-B model can be helpful tools in identifying and designing such interventions.

Tamryn Frank, R Swart, M Bopape, AM Thow, SW Ng, J Ostrowski. A Fit-for-Purpose Nutrient Profiling Model to Underpin Food and Nutrition Policies in South Africa.

Introduction: South Africa (SA) is facing a rising prevalence of obesity and diet-related chronic diseases. The government is seeking to develop effective, evidence-based policy measures to address this. A well-designed, fit-for-purpose nutrient profiling model (NPM) can aid policy development. Methods: The aim of this study was to develop a fit-for-purpose NPM in SA. Steps included: (1) determining the purpose and target population; (2) selecting appropriate nutrients and other food components to include; (3) selecting a suitable NPM type, criteria and base; and (4) selecting appropriate numbers and thresholds. As part of the evaluation, the nutritional composition of packaged foods containing nutritional information (n = 6747) in the SA food supply chain was analyzed, a literature review was undertaken and various NPMs were evaluated. Results and Discussion: Our findings indicated that it is most appropriate to adapt an NPM and underpin regulation with a restrictive NPM that limits unhealthy food components. The Chile 2019 NPM was identified as suitable to adapt, and total sugar, saturated fat, sodium and non-sugar sweetener were identified as appropriate to restrict. Conclusion: This NPM has the potential to underpin restrictive policies, such as front-of-package labelling and child-directed marketing regulations in SA. These policies will support the fight against obesity and NCDs in the country.

Savannah Froese, NS Gunaratna, S Kimenju, R Ambikapathi. Food Systems in Kenya: Gaps and Opportunities for Optimal Nutrition and Health Outcomes.

Introduction: Overnutrition and diet-related non-communicable diseases (NCDs) are increasing in Kenya. Using a food systems perspective, we synthesize current data on agricultural production of nutritious foods, food supply chains, food environments (FE), affordability of diets, dietary intakes, and associated NCDs. A food systems perspective, which also considers effects under climate change, aids in identifying research and policy recommendations to promote a more resilient and sustainable food system. Methods: Based on the approach used by Kawabata et al. (2020), we use published literature, public use databases such as the PMA 2020 Nutrition Survey, FAOSTAT, the Food Systems Dashboard, EM-DAT International Natural Disaster Database, Kenyan demographic health surveys, and national policy documents to synthesize the current status and trajectory of food systems in Kenya. Results: Rapid increases in NCDs in Kenya are associated with urbanization (among other factors) and shifting FE. Secondary cities in particular are experiencing rapid FE changes and population growth and will need stable access to health systems and nutritious food, especially under climate change. Meanwhile, marketing of energy-dense convenient foods by multinational and national companies needs further attention. Discussion and Conclusion: Benchmarking of FE policies offers a platform for multi-sectoral experts and interests to work together on addressing diet-related NCDs, while serving as an avenue to integrate food and health systems. Significant government investments in agriculture production, particularly in vegetable and fruit production, and value addition industries offer potential pathways to increase affordability and access to nutritious foods, while increasing inclusivity as food systems transition in Kenya.

Constance A Gewa, AC Onyango, RO Opiyo, L Cheskin, J Gittelsohn. Food environment in and around primary school children’s schools and neighborhoods in two urban settings in Kenya.

We conducted a cross-sectional study to provide an overview primary school children food environment in two urban settings in Kenya. Six schools, catering to children from low, medium and high-income households in the cities of Nairobi and Kisumu in Kenya, participated in the study. Data on types of food places and foods offered were collected and healthy and unhealthy food availability scores calculated for each place. Key-informant interviews were conducted with school officials in Kisumu to learn more about school-based food offerings. We utilized prevalence ratio analysis to examine associations between food availability, food place characteristics and neighborhood income levels. Altogether, 508 food places, located within 1 kilometer of the schools and the school children’s neighborhoods were observed. Open-air market sellers and kiosks were most common. The proportion of food places with high healthy food availability was 2.2 times greater among food places in Nairobi compared to Kisumu, 1.9 times greater in food places with multiple cashpoints, 1.7 times greater in medium/large sized food places and 1.4 times greater in food places located in high income neighborhoods. Key-informants acknowledged that school canteens prioritized food items that were most affordable and favorable to the school children, and that school policies on nutritional quality of school-based foods were generally lacking or vague if in existence. These findings highlight differences in availability of healthy foods and unhealthy foods across types of food places and neighborhood income levels, and the need for specific policies on food healthiness within schools and around schools.

Gideon Onyedikachi Iheme, A Adile, I Egechizuorom, K Oluwadamilare, O Ogbonna, L Olah, H Enuka, I Hajara, A Nwabumma, E Oyebamiji. Impact of COVID-19 Pandemic on Food Price Index in Nigeria.

Introduction: The economic effect of COVID-19 pandemic and lockdown on food access/demand can lead to food price changes. This study was designed to evaluate the covid-19 influenced differences in food commodity prices. Methods: The study design captured eight urban markets in Nigeria. Multi-stage sampling technique was employed. The number of sample points for each measure and commodity ranged from 2-4 per selected market. Weighted portions and corresponding price equivalents of the local measures of commodities sold by traders were obtained before, during and post-lockdown. Pre COVID-19 price served as the baseline for comparison Results: Results on the percentage price differences revealed that cereals/grains (lockdown – 4.87-23.53%; post-lockdown -38.68-65.16%), legumes/nuts (lockdown – 4.51-47.37%; post-lockdown -27.82-155.26%), egg/milk (lockdown – 12.69-16.46%; post-lockdown -18.28-29.86%) increased during the lockdown but worsened post-lockdown. Yam, sweet potato and cassava flour (alagbo) experienced a double increase in the post-lockdown (96.32-117.5%) price. Vegetables recorded a huge leap in price during lockdown (64.39-197.98%) than post-lockdown (-8.95% to 66.22%). Same was observed for goat meat (lockdown price – 30.0%; post-lockdown -12.38%). Other essential commodities such as oil, salt and sugar experienced price upsurge as well (lockdown; 3.82 -17.07; post lockdown; 0.31-21.9%). Conclusion: Food prices increased during the lockdown and worsened afterwards, efforts to eliminate food system disruptions will boost food production and enhance physical accessibility.

Sejla Isanovic, S Constantinides, E Frongillo, S Bhandari, E Kenney, S Sharraf, C Blake. Perspectives about food safety in diverse low- and middle-income countries.

Introduction: Concerns about unsafe food influence food choice, and consumption of unsafe foods increase morbidity and mortality, particularly in low- and middle-income countries. Addressing unsafe food is dominated by mitigation of biological and chemical hazards through supply-side risk management, disregarding individuals’ experiences and perspectives of food safety. We aimed to identify and categorize perspectives about food safety in five countries. Methods: Five Drivers of Food Choice projects provided transcripts from 17 focus groups discussions and 303 interviews in Kenya, Ghana, India, Guinea, and Vietnam. We analyzed transcripts using a priori and emergent codes. Results: Individuals constructed meaning about food safety through personal experience and social influences. Community and family members contributed knowledge about food safety. Concerns about food safety were influenced by reputations of and relationships with vendors. Concerns were amplified by mistrust of vendors’ purposeful adulteration or unsafe selling practices and of new methods used to produce food. Individuals were reassured of food safety by positive relationships with vendors; home-cooked meals; implementation of policies and regulations being followed; vendor adherence to environmental sanitation and food hygiene practices; cleanliness of vendors’ appearance; vendors’ or producers’ agency to use risk mitigation strategies; and transparency in production, processing, and distribution of food. Discussion: Assessment of food-safety policies in these countries will provide evidence about whether individuals’ perspectives about food safety are considered. Conclusion: Individuals’ perspectives about food safety influences food choices. Success of food-safety policies hinges on consideration of these perspectives.

Magnus Jirström, C Turner, HY Berhane, Y Berhane, S Abdelmenan, KE Selling, B Alsamius, L Wallberg, E-C Ekström. Food environments in Addis Ababa, Ethiopia: Investigating food availability among families with pre-school aged children.

BACKGROUND: The role of food environments in shaping transitioning diets is gaining attention, however evidence from SSA remains limited. OBJECTIVE: To assess the availability of healthy and unhealthy foods in the residential neighbourhoods of Addis Ababa and its association with neighbourhood wealth. METHODS: A multistage random cluster sampling of Addis Ababa identified 233 residential neighbourhoods including 5467 households. In each neighbourhood, an index household was identified and all vendors (2568) within 5 minutes walking distance were assessed for the availability of foods from 11 healthy and 8 unhealthy (high-energy dense/ultra-processed) food groups. Data were aggregated to the neighbourhood level for analysis. RESULTS: Food availability in residential neighbourhoods was generally high. Five of the eleven healthy food groups were available in 87-97% of neighbourhoods. The availability of meat, fish, and vitamin A rich fruits was low, at 21%, 42%, 36%, respectively. The availability of the 5 ultra-processed food groups was very high at 92-98%. Marginal differences in food availability were found when stratified by neighbourhood wealth. However, neighbourhoods in the lowest wealth tertile featured the lowest density of both healthy and unhealthy food groups. CONCLUSIONS: The availability of basic elements of a healthy diet is generally high while more nutrient-rich food groups are limited. Availability of all ultra-processed food groups were almost universal. The density of foods tended to be higher in wealthier neighbourhoods, in particular the unhealthy ones.

Alice Karanja, A Ickowitz, B Stadlmayra, S McMullin.  Understanding drivers of food choice in LMICs: a systematic mapping study.

Introduction: Understanding individual-based motives governing food choices is necessary to design appropriate interventions and support food systems consistent with the food environment, consumer characteristics, preferences and values. Methods: We used a systematic mapping approach to identify and systematize available evidence on drivers of food choice in low- and middle- income countries. We mapped geographical and topical areas where there is emerging evidence to build on and understudied areas requiring more strategic empirical research. Results and discussion: We identified a list of forty (40) individual-based motives which were sorted into seven clusters. Most studies focused on adults and women-specific aspects of food choices, especially those investigating the role of cultural-based food taboos and diet restrictions. Studies related to the dimensions of the food environment focused on food affordability, convenience, promotional information and food availability. Sub-Saharan Africa, was the most studied region in understanding drivers of food choice followed by East Asia and Pacific, and South Asia. Heatmaps of the current evidence across rural-urban landscape configurations revealed that existing studies are skewed towards urban settings with a dearth of studies in rural and peri-urban contexts. Conclusion: Based on our review, we highlight areas for future research and the need to adopt systemic and spatially explicit research frameworks that appreciate cultural and socioeconomic contexts of consumers. This review thus presents a resource that can support on-going efforts to advance knowledge of dietary behaviors and contextual efforts necessary to promote healthier diets.

Alice Scaria Khan, R Swart, T Frank. Child-directed marketing on pre-packaged breakfast cereals in South Africa.

Background: Childhood obesity is on the rise in South Africa (SA) and child-directed marketing (CDM) is one of the contributing factors to children’s unhealthy food choices and consumption. This study assessed CDM on pre-packaged breakfast cereals available in South African supermarkets and described the nutrient composition of these pre-packaged products. CDM was defined as the use of on-package marketing technique(s), targeting children under the age of 18 years. Methods: A descriptive observational study of CDM on pre-packaged breakfast cereals was undertaken with quantitative analysis of the nutrient composition. The CDM questionnaire was developed in REDCap, an online research database and data captured therein. Cross tabulations and one-way ANOVAs were performed during analysis. All analysis with p value < 0.05 was taken as significant. Results: CDM strategies were classified as direct (to the child) or indirect (through the parent). A total of 222 breakfast cereals were studied, of which 96.9% had a nutritional or health claim, 95.0% had illustrations, 75.2% had product and consumption appeals, 10.8% had characters, 10.8% consisted of different appeals, 8.6% alluded to fantasy and 7.7% had role models. In breakfast cereals with direct CDM the protein and fibre content were significantly lower while the total carbohydrate and total sugar content were significantly higher than in breakfast cereals without direct CDM. No significant difference was found in the energy and sodium content. Conclusion: CDM was found to be prevalent in breakfast cereals sold in South Africa and the ready-to-eat (RTE) breakfast cereals were excessive in some nutrients of concern. Policies to regulate CDM of pre-packaged breakfast cereals is recommended.

Matthew Yosah Konlan, P Konka, HAK Abiwu. Assessing consumer understanding of food labels and use in making a healthy dietary choice.

Introduction: Creating supportive food environments that influence consumers to make healthy food choices and/or food industry to improve the healthiness of their food products can contribute in addressing the rising burden of obesity and nutrition-related non-communicable diseases (NR_NCDs). Food labeling is one typical example of a population-based approach that helps consumers to make healthful choices of packaged foods at the point-of-purchase. This review aims to assess consumer understanding of food labels and use in making a healthy dietary choice. Methods: A systematic review was conducted by searching electronic databases. Recently published (2012-2020) relevant articles were screened by authors and included if they met the inclusion criteria. Ten articles, which met the inclusion criteria were included in this review. The articles were evaluated and findings were combined with assessments made by authors of food labels in Ghana Results: We found that consumer self-reported understanding of food labels was high. However, an objective measure of label understanding revealed otherwise. The self-reported use of food labels was high. However, an objective measure of the use of food labels in making a healthy choice may reveal otherwise. Expiry date, health claims, nutrition content, price, instruction for use, storage information and advertisement influenced the use of food labels. For those who used nutrition content, fats, sugar and cholesterol were mostly used. Nutritional value of the product, health consciousness, religious beliefs, preference of some food ingredients, food allergy motivated consumers to read food labels. Common difficulties encountered in the use of food labels included unfamiliar language other than English-foreign language, small font sizes, when in hurry, technical/scientific language. Discussion: Our finding that self-reported understanding and use of food labels is high is similar to the findings in Europe, which reported that the self-reported understanding and use of nutrition labels was high (Cowburn and Stockley, 2004). Conclusions: Self-reported understanding and use of food labels is high in Ghana. However, an objective measure revealed that understanding of food labels is rather low. Government of Ghana and the food industry needs to explore new formats of improving understanding of food labels and use in making a healthy choice among consumers.

Akua Tandoh, IA Kumi, AK Laar. Healthiness of Foods and Beverages Advertised on Ghanaian Television Programmes Targeting Children.

Introduction: The advertisement of energy-dense nutrient-poor foods and non-alcoholic beverages to children remains a pressing public health concern. Evidence shows that persistent exposure to food advertisements influences children’s food preferences, purchases, and consumption behaviour. This study assessed the healthiness of foods and non-alcoholic beverages advertised on Ghanaian television programs targeting children. Methods: Three television channels were purposively selected, and programmes were recorded over a four month period. The composite week sampling technique was used to sample the days for recording. Content analysis of advertised food and beverage products was undertaken, and healthiness was categorized as healthy, unhealthy, and miscellaneous. Results: Of the 1,926 adverts recorded, 590 were of foods and beverages. The most advertised foods were sugar-sweetened beverages (25.8%); followed by snacks (12.8%), milk and yoghurts (12.4%), instant noodles (7.1%), candy/chocolate and ice creams (6.4%), breakfast cereals and beverages (5.3%), fruits (2%), water and vegetables (<1.5%). The most used persuasive technique were those utilizing sensory-based attributes such as taste, texture, appearance, aroma (44%), suggested product use for or by children (30%), use of animation, children, cartoon characters (29%), health claims (18%), portrayed happiness fun and pleasure (14%). Conclusion: Unhealthy food adverts are broadcast on TV programmes targeting Ghanaian children and are accompanied by at least one persuasive technique that could influence children’s food purchase and consumption of energy-dense nutrient-poor foods. Regulatory mechanisms are required to limit broadcast advertising of such foods to protect the health of children in Ghana.

Julia Liguori, U Trübswasser, R Pradeilles, A Le Port, E Landais, E Talsma, M Lundy, C Béné, N Bricas, A Laar, MJ Amiot-Carlin, I Brouwer, M Holdsworth. How do food safety concerns drive consumer behaviors and diets in low- and middle-income countries?

Introduction: Food safety and dietary behaviors are major contributors to the global burden of disease. The impact that food safety concerns have on dietary behaviors in low- and middle-income countries (LMICs), especially in rapidly urbanizing environments, is insufficiently documented. Methods: We conducted a systematic review to determine whether food safety concerns influence consumer behaviors and diets in LMICs. We used a socio-ecological food environment framework to map how food safety factors influence consumer behaviors (food acquisition/purchase, eating out of home, food preparation/storage) and diets (nutritious/non-nutritious foods) within the food system. Results: We identified 46 studies from 20 LMICs. Consumers were worried about food safety, but could not always take the necessary steps to acquire safe food. Concerns are often outweighed by food price, accessibility, convenience and appeal. Key issues included fear of pesticides, fertilizers, hygiene in/around food outlets, vendor practices and household storage/preparation methods. There was some evidence that these concerns reduced consumption of animal sourced food and fresh fruit/vegetables; and increased consumption of non-nutritious and processed/packaged foods. Discussion: Consumers have myriad of risk mitigation strategies such as: eating out less frequently, observing hygiene in and around food outlets, kinship networks and household practices, to avoid illness and unsafe foods. Conclusion: Policies such as upgrading urban market infrastructure to enhance food safety, accompanied by nutrition education, could lead to increased accessibility and appeal of safe, nutrient-rich food and reduce the appeal of packaged/processed food; thereby contributing to preventing foodborne disease and multiple forms of malnutrition.

Vincent Linderhof, M Dijkshoorn-Dekker, E Obeng, E Bulten, W de Haas, Z van Eldik, V Nigten, A Laar. Transition pathways to a transformed urban food environment for healthy diets for all: the case of Accra, Ghana.

Introduction: Although there is a common understanding regarding how healthy and sustainable diets should look like, there is no magic bullet approach as to how urban food environments can assure sustainable healthy diets. Current food environment literature presents diverse scenarios for assuring healthier diets. Accordingly, there are multiple ways of transitioning to healthier diets in urban food environments. The actors’ diversity in the urban food environments produce divergent views on how urban food environments could contribute to healthier diets. Therefore, there is a need for shared vision and common transition pathways to avoid a deadlock. Method: We propose two workshops to explore pathways to transitioning Accra’s current urban food environment into one that assures healthy and sustainable diets. This exploration of pathways is conducted with a bottom-up approach including a stakeholder analysis, stakeholder engagements, policy analysis and landscape analysis. The advantage of this exploration is that stakeholders with differences in their background and experiences have a dialogue to become more aware of each other’s preferences and conditions for change. Results and discussion: The workshops will be conducted in November and December 2021. Adhering to the principles of multi-stakeholder inclusivity, the stakeholders invited to these workshops will span the entire spectrum of the food environment – state and non-state actors, the private sector, NGOs, academics and civil society. The first step is to identify common aspects of transitions. The second step is to have dialogues about what is expected from members and stakeholders in terms of investment, adjusting regulation, enforcement, promotion etc.

Tjale Cloupas Mahopo, CN Nesamvuni, J Van Niekerk , AE Nesamvuni, M de Bruyn, R Ambikapathi. Characterizing the operations of the street food enterprise in the Vhembe district, South Africa.

Objective: To characterize the operations of the street food enterprise in the Vhembe district, focusing on business profile, sold foods, inputs, pricing, record-keeping practices, and total running cost. Methodology: A descriptive cross-sectional face-to-face study of 511 vendors was done using a structured researcher-administered questionnaire comprised of demographic and operational characteristics. Convenience sampling was used to select the vending sites. Results: The results highlight the dominance of single middle-aged (35-44) (63.1%) women with some high school education. About 14% migrated from Zimbabwe. Most of the vendors were full-owners (86.1%) with 70.0% in business for at least one to ten years. Food sold included mielie pap [ stiff porridge] served with beef or chicken, sometimes with vegetables. Plate prices were R44.2±R7.7 for a full plate and R30.9±R8.7 for half a plate. Government officials, middlemen, and school children were the most common consumers of street food. The vendors used social media and word of mouth to communicate with their customers. The results highlight poor managerial skills as only 15.5% kept records, most of which were sales records (59.5%). On average, street vendors made a monthly profit of R4098.8±R4031.3 while they spent R2470.8±R2185.5 on running expenses daily. There were statistically significant variations in some operational characteristics of vendor variables and gender, age, marital status, and citizenship. Conclusions: There is a need for capital and management for small businesses and food training for rural street food vendors. Therefore, government officials, policymakers, and NGOs could target street vendors to offer training and microfinance to improve their business skills, while also promoting food safety and consumption of nutritious foods.

Anthony Muchai Manyara, E Mwaniki, J Gill, C Gray. Barriers and facilitators of healthy eating in a low-income and middle-income community in Nairobi, Kenya: A qualitative study.

Introduction: Understanding local perceptions, experiences and factors influencing healthy eating is important to develop interventions that maximise on engagement and potential effectiveness. This study aimed to explore the barriers and facilitators of healthy eating in two different communities in Nairobi, Kenya. Methods: Participants were recruited from one low-income community (n=15, 7 female) and one middle-income community (n=14, 6 female). In-depth interviews were audio recorded, transcribed verbatim, and thematically analysed. Results: Lack of knowledge of the recommended portions of fruit and vegetable may have failed to facilitate adequate fruit and vegetable intake. Additionally, perceived benefits of healthy eating and perceived consequences of unhealthy eating could have motivated the consumption of healthy diets. Also, upbringing was mentioned as one of the main social influences on (un)healthy eating and another was social norms such as associating western diets with high socioeconomic status. Furthermore, the unaffordability of healthy foods (mainly in the low-income community), availability and affordability of unhealthy foods (in the middle-income community) and safety concerns of healthy foods in both communities were mentioned as barriers to healthy eating. Finally, meal plans were proposed as facilitators of healthy eating. Conclusions: Interventions to promote healthy diets should increase knowledge of the composition of healthy diets, increase understanding of benefits of healthy diets and consequences of unhealthy diets, and support people to develop meal plans. Further, there is need to increase affordability of healthy foods in the low-income community, restrict availability and affordability of unhealthy foods in the middle-income community, model consumption of healthy diets at household level, and ensure food safety.

Natasha Mazonde, SA Karim, P Mushamiri, P Kruger, K Hofman, S Goldstein. Media coverage of the Health Promotion Levy (HPL) in South Africa.

Background: A health promotion levy (HPL), as it is referred to in South Africa is the tax on sugar sweetened beverages (SSBs), was first mooted in 2015 and implemented in April 2018. We aimed to show how introduction of the HPL was deliberated in the South African online media, and how this changed over time; Methods: We performed a quantitative and qualitative discourse analysis of online news articles identified through the Meltwater database. Fifty articles were selected and analysed qualitatively based on diversity of publication, sentiment and voice; Results: The media landscape was highly reactive to the HPL introduction. Framing of the tax shifted over time related to key milestones in the policy-making process. South Africa’s experience in adopting the HPL mirrored similar global news media experiences, and fueled debate on the complexities around implementation of health policies to address non-communicable diseases (NCDs); Conclusions: This study contributes to on-going debates on how media coverage of health interventions influences policies and public opinion, and how introduction of the HPL in South Africa contributed to shifts in the purchase and intake of SSBs. These findings provide useful lessons for countries intending to adopt a similar health policy intervention.

Natasha Mazonde, S Goldstein. Online health communities’ portrayal of obesity on social media platforms in South Africa.

Background: The rapidly increasing prevalence of obesity in South Africa, intertwined with extensive changes diet and food choices has led to a complex framing of obesity on social media. To leverage social media for obesity prevention, we need to understand how the health issue is portrayed online. This study was conducted to understand how obesity is constructed and represented on social media in South Africa. Methods: A cross sectional mixed methods study design with qualitative framing analysis and quantitative content analysis of Facebook and Twitter in South Africa over a six month period. The study used Meltwater software for data collection and data were extracted by the researcher yielding 13 500 posts and tweets. Data were cleaned and coded in Microsoft Excel. Results: Representation of obesity on social media in South Africa suggests a complex health issue depicting stigmatising portrayals largely blaming individuals for unhealthy lifestyles and poor diets leading to obesity. Social media engagement with obesity messaging is both passive and interactive. There is a mix of voices creating obesity content including health advocacy groups, health experts, and media personalities. Conclusions: This study documented media portrayals of obesity. With social media intricately embedded in the social lives of South Africans, there is a high likelihood that obesity prevention efforts will turn to social media to reach out to the public. Future research and media-based prevention efforts need to leverage social media to fully understand the discourse around obesity.

Moses Mokaya, F Kyallo, C Matthys, R Vangoitsenhoven, E Saruni. Environmental factors influencing Dietary Intake in Adults with Type 2 Diabetes: A Kenyan Qualitative Study.

Introduction: Approximately 2.2% of the adult population in Kenya has diabetes and nearly two-thirds has undiagnosed diabetes. Diabetes is associated with all-cause mortality and cardiovascular diseases. Kenya is in the nutrition transition, where the food environment influences unhealthy dietary choices. Dietary behavior and the food environment are important drivers in the control of type 2 diabetes. However, there is little information on the specific drivers of the disease in Kenya. Purpose: To explore the barriers and facilitators to dietary intake in adults with type 2 diabetes. Methods: A qualitative study using telephone interviews was conducted between August and December 2020. Respondents included adults with type 2 diabetes from six hospitals. A semi-structured questionnaire was administered through electronically recorded telephone interviews. The questionnaire collected data on perceived dietary behavior and food environment. The NVivo 12 Software was used for inductive content analysis. Results: Thirty interviews were conducted, each lasting between 27-47 minutes. The average age of the respondents was 56 years (Range 33-80 years). The four leading identified facilitators to dietary intake include knowledge on the benefits of food, owning gardens or farms, access to healthy food, and proximity to food selling points. Four leading barriers that were identified include inaccurate beliefs, tastes and preferences, socio-economic factors, and seasonality of fruits and vegetables. Conclusion: Facilitators and barriers to dietary intake in adults with type 2 diabetes in Kenya are influenced by knowledge on healthy dietary patterns. Promoting food literacy is a potential approach to health dietary intake.

Mulenga Mary Mukanu, AM Thow, P Delobelle, Z Mchiza. Determinants of dietary patterns of school going adolescents and their policy implications in Zambia.

Background: The double burden of malnutrition in developing countries has been associated with unhealthy food consumption. This study aimed to identify drivers of dietary patterns of school going adolescents in Zambia using a food environment lens and analyse its implications on food policy. Methods: We conducted 20 focus group discussions using a structured topic guide with grade 10 pupils from ten secondary schools in Lusaka. Turner’s framework which conceptualizes the food environment into external and internal domains was used to guide thematic data analysis and results interpretation. Results: Adolescents stated their food choices are largely based on personal preference linked to the need for social acceptability among peers. Adolescents felt their food choice was limited to ‘cheap junk foods’ which were readily available at school. Healthy foods like fruits were reportedly inaccessible and unaffordable. Some adolescents stated they were attracted to certain foods by adverts they see on TV and social media. Discussion: Our findings show that school food environments do not support healthy dietary patterns as cheap snacks are widely available while fruits and other healthier food options are unavailable. This presents an opportunity to introduce policies on food vendor zoning around school premises and to strengthen existing policies restricting food sold in school tuck shops. Indiscriminate marketing of unhealthy foods like sugar sweetened beverages to adolescents requires implementation of stronger food marketing regulations. The strong peer influence on food choice can be leveraged to promote school based peer led health promotion interventions. Conclusion: The identified factors shaping adolescent dietary patterns provide opportunity for food policy reforms in Zambia.

Patience Mushamiri-Kuzviwanza, S Goldstein. Use of child-directed persuasive marketing techniques on television in South Africa.

Introduction: Consumption of unhealthy diets by children has contributed to the high prevalence of childhood obesity in South Africa. The use of child-directed persuasive marketing techniques on television is of concern as it plays a role in children’s dietary choices and promotes children’s consumption of unhealthy food, such as sugary foods products. Methods: Following industry pledges made relating to the reduction of child-directed marketing of unhealthy foods, this study aimed to describe the frequency of advertisements for sugary food products and the advertising techniques being used to appeal to children on South African TV channels. Advertisements aired during children’s and family viewing times, over a two-week period on two South African free-to-air channels were recorded. An analysis of the frequency of advertisements as well as the techniques of advertising used was carried out. Results: Results from the study revealed that 13% of all advertisements aired were for food products, with more than 40% of those being for sugary foods. On one of the channels, close to 80% of the food advertisements aired during children’s viewing times were for sugary foods. Various persuasive marketing techniques were identified as being used in the advertisements to directly appeal to children. Discussion and Conclusion: These findings highlight how industry self-regulation continues to be ineffective in limiting children’s exposure to unhealthy food. It also shows the importance of government legislation whose aim is to stop child-directed marketing of unhealthy food products, with additional specific limitations on the use of persuasive techniques when advertising to children.

Kovania Naidoo, V Van Der Westhuizen. Investigating and mapping out the obesogenic food environments within predominantly Indian communities in the city of Durban, South Africa.

Objective: The objective of this study was to investigate and map out the food environments within predominantly Indian communities in the city of Durban, South Africa.
Setting: Tongaat, Verulam, Phoenix and Chatsworth were chosen as the communities of interest as they are the four largest predominantly Indian communities in Durban. Design: Data was gathered using Geographical Information Systems (Google Earth®) to determine the Modified Retail Food Environment Index (mRFEI). The mRFEI measures the number of healthy formal food outlets out of the total number of outlets. Results: The mRFEI scores showed all the food environments to be within the healthy range. Tongaat was found to have the healthiest food environment, followed by Chatsworth, Verulam and Phoenix had the unhealthiest food environment. Discussion: It is hypothesized that Tongaat is the healthiest due to the lower household income and Phoenix is the unhealthiest due to the higher household income. Higher household income has been associated with an increase in the consumption of fast foods and thereby an increased risk of obesity. It is also hypothesized that Indian cooking methods and not the food environments may be responsible for the incidence of obesity amongst Indians due to the use of oils, saturated fats, high sugar and high salt usage. Conclusion: More studies are required to substantiate these judgements as there is currently limited research available on the South African Indian diet and health status.

Noella Nyirangirinshuti, ME Laar, C Nti, C Mukantwali. Choice of food retail outlets and nutritional outcomes among poor urban dwellers in kamashangi cell, Rwanda.

Introduction: Food retail outlets is rapidly changing in developing countries where modern retail outlets is replacing traditional outlets. These changes also change people’s food choices and thus their nutrient intakes, health and nutritional status. The study aimed to determine the relationship between the choice of food retail outlets and nutrient intakes among adults in the poor-urban community of Kamashangi cell, Rwanda. Methods: Using a cross-sectional study design a household survey involving 360 adults aged 20 – 60 years was conducted. Information on respondent’s choices of food retail outlets was collected. A single 24-hour dietary recall was used to assess participants’ nutrient intakes and anthropometric data to determine respondents’ BMI. Data was analyzed using STATA. P ≤ 0.05 was considered significant. Results: The study revealed that 90% of the respondents purchased their foodstuffs from the traditional retail outlets. Calcium, vitamin A and folic acid intakes were low for all study participants regardless of their preferred retail outlets. About 31% of participants were overweight and 15.8% were obese with females being more obese (<0.001). The study found a significant relationship between choice of food retail outlets and the nutrient intakes, as well as between choice of food retail outlets and nutritional status. Discussion and conclusion: Unless measures are taken, the expansion of supermarkets is likely to have negative consequences on the health of poor urban dwellers in Kamashangi. This may exacerbate the prevalence of diet-related chronic diseases. It is therefore recommended that nutrition institutions should help people to keep the good habits of purchasing from traditional retailers.

Lucia Segovia de la Revilla, E Joy, E Ferguson, C Dooley. Current availability of food composition data in sub-Saharan Africa.

Estimates of population micronutrient intakes rely on the availability of relevant food consumption and composition data. However, food composition tables (FCTs) for use in sub-Saharan Africa (SSA) are scarce, provide outdated information and often rely heavily on imputed data from other geographies. This is particularly problematic for the mineral micronutrient composition of staple crops where there is important geospatial variability in crop composition due to factors such as soil type.
We conducted a scoping review to identify published food composition datasets used for dietary assessment of the mineral micronutrients calcium, iron, iodine, zinc and selenium in SSA for highly consumed food items. We identified 106 studies using food composition data to estimate dietary mineral supplies, of which 20 used the USDA FCT while 18 used the FCT for use in Africa (1968). In total, we identified 21 FCTs covering 18 geographic locations published between 1961 and 2021. Iron and calcium composition of foods were included in nearly all FCTs (21 and 20 FCTs, respectively). Iodine was the least reported (n=4) followed by selenium (n=6). Most FCTs reported using data from US or other countries outside Africa, although detailed information regarding the actual geographic location of the micronutrient data was often missing. Our study highlights the limited availability and poor documentation practices of food composition data across SSA. This constrains our ability to estimate dietary mineral micronutrient intakes and risk of deficiency in SSA.

Winnie Sambu, F Picchioni, C Turner, EA Codjoe, PK Nkegbe, S Stevano. Evidence and Gap Map on consumption of industrial diets in Ghana: what does the current evidence tell us?

Dietary patterns in Ghana have become increasingly westernised with links to poor nutritional outcomes such as overnutrition and related non-communicable diseases. Existing evidence suggests that studies examining dietary patterns and poor nutritional outcomes tend to focus on adult populations and less on other demographic groups. This Evidence and Gap Map (EAG) examines the extent to which research on adolescents’ dietary patterns and nutritional outcomes in Ghana addresses seven key aspects of food systems (policy environment, food availability, affordability, convenience, desirability, food consumption, and nutritional and health outcomes), and identifies the prevalence of micro-meso-macro scale analysis. We searched three main databases (Scopus, Web of Science and PubMed), and found 23 articles that met our inclusion criteria. The EAG found methodological gaps, with very few mixed methods and/or cross-disciplinary research. The majority of the studies (57%) were primary cross-sectional employing quantitative methods. Findings reveal that food consumption has been the most popular domain, included in over 90% of the studies, whilst very few studies have examined food policy and governance, and hardly any have linked the macro/meso levels to micro-level analysis. Another striking finding was the lack of studies on food cost, consumer knowledge and awareness, links to power and decision-making. Our review suggests the need for future research to consider these key knowledge gaps to generate evidence for design and implementation of policies and interventions to improve adolescents’ nutritional outcomes.

Rina Swart, M Bopape, T Frank. Evaluating FOPL on packaged food products in South Africa.

Introduction: The increasing range and diversity of processed food options in South Africa make it difficult for consumers to make informed healthier choices, fuelling excessive consumption of nutrients associated with increased risk for non-communicable diseases. Methods: The aim of the randomised control trial (n=1949) was to determine the effectiveness a warning label (WL), the GDA and the Multicolour Traffic Light (MTL) to help consumers identify foods high in nutrients of concern as well as foods that are unhealthy. Each participant was exposed to only ONE random FOPL on three single products and three pairs of products. Ethics approval was received from UWC BMREC (BM18/9/13). Results: The WL performed better than the GDA and the MTL to inform participants about food products that are high in nutrients of concern as well as on the unhealthiness of the product(s). Both the GDA and the MTL incorrectly informed participants on “high in” nutrients of concern (3 out of 9 times and 5 out of 9 times respectively) as well as on its unhealthiness on some products (3 out of 6 times for both). Discussion: A warning label can be effective to convey information on products that are high in nutrients of concern and which thus should be avoided or replaced by similar products that are less unhealthy. Conclusion: We propose the WL as a mandatory FOPL for South Africa.


Ursula Trübswasser, J Candel, T Genye, A Bossuyt, M Holdsworth, K Baye, EF Talsma. Benchmarking policy goals and action for healthy food environments in Ethiopia to prevent malnutrition in all its forms.

Introduction: Unhealthy diets resulting in overweight and obesity and diet-related non-communicable diseases are of increasing concern in Ethiopia, alongside persistent undernutrition, and have been linked to unhealthy food environments. Little is known about the policy response to unhealthy food environments in Ethiopia. The objective of this study was to assess how different food environment domains have been addressed in Ethiopian policy goals and action over time and how this compares with global good practice benchmarks. Methods: We analyzed policy documents (outputs of decision-making in the form of published strategies, plans or policies) related to improving diets and nutritional status through healthy food environments in Ethiopia between 2008-2020. Results: The 8 food environment domains of the Healthy Food-Environment Policy Index (Food-EPI) guided our coding framework. Thirty-eight policy outputs were retained from 127 identified; published by 9 different government ministries and institutions. Our results show that the food environment domains have been addressed to some extent, but gaps remain compared to global best practice, especially in food promotion, processing, retail, price, and trade. Since 2018, policy began to embrace the wider food system with more explicit food environment interventions becoming apparent. Discussion and conclusions: Policy efforts achieved in food safety, food processing, marketing, and labelling are important steppingstones to strengthen future policy actions addressing food retail, food provision and food trade. Benchmarking of food environment policy actions should also consider actions on food fortification, agro-processing and informal markets in a context of multiple forms of malnutrition.

Charles Lwanga Tumuhe. Preserving and utilizing the genetic materials of indigenous crops and plants for nutrition and preservation of genetic diversity.

There is an immutable need to preserve and utilize the genetic materials of indigenous crops and plants for nutrition and preservation of genetic diversity. The scientific community needs to support farmers in the preservation of indigenous foods and seed. African Rural University (ARU) participated in indigenous seed and food fairs to collect data while showcasing the preservation, preparation, value addition and consumption of local seeds and foods in Uganda. The purpose of the traditional seed and food fair events was to demonstrate both the existence and resilience of African culture in food and nutrition through participation of farmers and ARU students. There were three series of such fairs at local (10 groups), regional (49 groups) and national levels (30 groups). ARU research team and students participated in all the fairs as both exhibitors and researchers. Results indicate that exhibitors showcased traditional/indigenous foods both in raw and cooked forms. There is still a wide variety of beneficial indigenous and traditional foods in Uganda. It may be helpful to establish a complete traditional food data system for all ethnic groups in Uganda and prepare recipes for preparation of their traditional dishes, establish botanical gardens for conservation, earth markets and more regular food and seed fairs for farmers to interact and exchange the planting materials.

Cristiana K. Verissimo, R Ambikapathi, L Galvin, SL Froese, C Patil, M Boncyk, S Ghosh, E Kumalija, D Mosha, J Jeong, MP Kieffer, M Mwanyika-Sando, AK Yousafzai, G Praygod, NS Gunaratna. Gendered home food environments are central to children’s dietary diversity in rural Tanzania.

Introduction: Optimal nutrition during the first two years of life is critical for development. At this age, caregiver behaviors determine children’s diets. In addition to mothers, fathers’ nutrition knowledge can influence children’s diets and fathers are often key decision-makers. We investigate how men and women shape the home food environment to determine children’s diets. Methods: This study uses baseline data from the Engaging Fathers for Effective Child Nutrition and Development in Tanzania (EFFECTS) trial ( Identifier: NCT03759821), including 960 rural households with both parents and a young child. Linear mixed models were used to examine associations between parental nutrition knowledge, couples’ relationship dynamics, social support, and household savings and 7-day dietary diversity among children 9-23 months (n = 597). Results: Mothers’ knowledge of foods for growth (0.13 [SE 0.04], p<0.001) and for nutritious porridge (0.13 [0.06], p=0.02), and their reports of social support (0.25 [0.11], p=0.02), involvement in household decisions on agricultural production and household income (0.07 [0.02], p<0.01), couples’ communication frequency (0.06 [0.02], p<0.01) and quality (0.06 [0.02], p<0.001), having household savings (0.23 [0.11], p=0.04), and parents’ joint report of having household savings (0.41 [0.15], p<0.01) were associated with more diverse diets among children. Discussion and Conclusion: Mother’s nutrition knowledge, social support, and household savings were associated with improved child diets. Gender equity, especially around communication and decision-making on agricultural production and household income had positive associations with child dietary diversity. Interventions must address the gendered nature of the home food environment to enable optimal diets for young children.

Ayala Wineman, A Mitchell, H Kessler, A Martin-Daihirou, L Bigayimpunzi, MG Nyangmi, N Jacquet. Regional Results from the 2019 Global Survey of School Meal Programs.

School meal programs—through which students are provided with meals, snacks, or take-home rations—operate throughout Africa. These programs serve as a safety net and aim to improve children’s nutrition, influence their dietary choices, and strengthen the agrifood economy through local procurement. The Global Survey of School Meal Programs © was launched in 2019 and captures detailed information on school feeding activities in each country. Forty-one countries in Africa (38 in sub-Saharan Africa) responded to the survey in 2019 with information on 68 large-scale programs that together reached 56 million children. Across these countries, the aggregate school feeding budget was 1.3 billion USD. It was more common for programs to target children in primary school than in preschool, secondary school, or vocational school. Contrary to some assumptions, food was more often sourced through domestic purchase than foreign in-kind donations, and domestic purchase was associated with more diverse menus. To address micronutrient malnutrition, about two-thirds of the programs served fortified foods, and one-quarter included micronutrient supplements. The private sector was engaged in about one quarter of the programs, while farmers were engaged in about half, with local procurement of food items reported to increase the incomes of family farmers. Nevertheless, the programs grappled with inadequate and unpredictable budgets and challenges related to infrastructure and supply chains. The survey results underscore the important position of school meal programs within African food systems and their potential (if well-designed) to sustainably improve food security. A second survey round is underway in 2021.

Annabel Yeboah-Nkrumah. Dietary intakes and Nutrient gaps in the diets of women in a poor urban Ghanaian community.

Introduction: Women are the most vulnerable segment of the population in both cases of nutrition transition and food and nutrition insecurity in Sub-Sahara Africa. This affects their health and nutritional status, and to a higher degree because of the high nutritional demands associated with pregnancy and lactation. The aim of the study was to determine the dietary intakes and the nutrient gaps that exist in the diets of women in a poor urban community in Ghana. Methods: A cross-sectional study design using a quantitative approach was used for this study. The study was conducted in Kissieman, a poor urban community in the Greater Accra region. Two hundred and fifty-four (254) women of reproductive ages (15-49 years) participated in the study. A 24-hour dietary recall was used to determine the nutrient intakes and the minimum dietary diversity of the respondents and anthropometric measurements (weight and height) were taken to determine their Body Mass Index (BMI). Results: Results of the study show that all the nutrient intakes were inadequate in this study population (the adequacy ratio (AR) was ≥ 100%). Energy, protein, niacin and vitamin C, intakes were fairly adequate (66% < AR < 100%). Intakes of thiamin, riboflavin, vitamin B6, vitamin B12, vitamin A, folate, calcium, iron, sodium and zinc were inadequate (AR < 66%). Folate intakes among the respondents were particularly very low (AR = 4.59%). Educational status was found to have a significant influence on the intakes of protein (p=0.010), niacin (p<0.001) and thiamin (p=0.044). The study revealed that starchy staples (grains, cereals, roots and tubers) were the most (99%) consumed whiles fruits were the least (7.9%) consumed. The minimum dietary diversity for women (MDD-W) of the respondents was 3.91 signifying poor dietary diversity. The prevalence of poor MDD-W was 75%. Dietary diversity was significantly associated with marital status (p=0.012) and educational level (p=0.028)of the respondents. The mean BMI for the population was 27.5 kg/m2 (± 6.4), 40.9% of the respondents had a normal weight, 2.8% were underweight, and 56.3% we overweight/obese. The result showed a significant relationship between iron intakes and BMI of the respondents (p=0.049). Again, a significant association was observed between BMI and age (p=0.00); marital status (p=0.000); educational level (p=0.007) and occupation (p=0.009). Discussion and Conclusion: The diets of the respondents were very low in vitamin B6, vitamin B12 and folate. Dietary diversity of the respondents was poor and a little over half of the women were overweight/obese. It is therefore recommended that nutrition education programs targeted at both vendors and consumers be intensified to improve dietary patterns of poor urban dwellers. These efforts should especially promote dietary diversity with simplified and practical key messages. Additionally, with the ongoing tree planting exercise in the country, government should provide more fruit tree seedlings to communities for planting to make fruits easily available and accessible.

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